HTK液与含血停搏液用于瓣膜置换联合房颤射频消融治疗患者术中心肌保护的研究  

The cardio-protective effects of HTK solution and conventional blood cardioplegia in patients underwent valvular surgery combined with radio frequency atrial ablation:a randomized controlled study

作　　者：辛梅[1] 赵凯[2] 倪尔连 刘刚[1] 邬晓臣[1] 岳琴[1] 魏晓红[1] 欧阳辉[1] 金振晓[3] 张近宝[1] 

机构地区：[1]成都军区总医院心血管外科,成都610083 [2]成都军区总医院神经外科,成都610083 [3]第四军医大学西京医院心血管外科,西安710032

出　　处：《中国体外循环杂志》2013年第4期207-212,共6页Chinese Journal of Extracorporeal Circulation

摘　　要：目的比较HTK液及含血心肌保护液对瓣膜置换合并房颤射频消融手术患者的心肌保护效果及其对临床预后的影响。方法 2011年7月至2012年2月,连续36例瓣膜病合并房颤拟行瓣膜置换(或成形)并同期行房颤射频消融治疗患者纳入本研究,随机分为两组:HTK液组采用HTK液作为心肌保护液,单次灌注诱导心脏停搏;含血停搏液组使用1∶4含血心肌保护液,在心肌缺血期间每隔20min灌注一次。分别在术前(T1)、主动脉开放后2h(T2)、术后24h(T3)和术后48h(T4)采集血液检测血清肌钙蛋白T(cTnT)、肌酸激酶(CK)、心肌型肌酸激酶同工酶(CKMB)、肌型肌酸激酶同工酶(CKMM)浓度,同时记录患者围术期心律失常的发生率、术后机械通气和ICU停留时间、并发症发生情况及临床转归等数据。结果 HTK液组患者平均灌注量(1 922.2±399.3)ml;含血停搏液组患者平均灌注(3.06±0.72)次,平均灌注量(2 837.3±249.6)ml,两组患者心脏均停跳良好。两组患者血液中的cTnT、CK、CKMB和CKMM浓度在主动脉开放后2 h时均显著升高,术后24h时仍处于较高水平,术后48h时呈下降趋势。HTK组血清cTnT、CK、CKMB和CKMM浓度在开放后2 h、术后24 h、术后48h均显著低于含血停搏液组。HTK组体外循环费用显著高于含血停搏液组(P<0.05);随访期间两组患者生活质量评价无显著性差异。结论瓣膜置换合并房颤外科治疗术中应用HTK液进行心肌保护,围术期心肌损伤酶学指标较含血停搏液有所改善,对术后恢复作用与含血停搏液相似。Objective To compare the cardio-protective effects and clinical outcomes of HTK solution and conventional blood cardioplegia in patients underwent valvular surgery combined with radio frequency atrial ablation.Methods Thirty-six consecutive patients scheduled for valvular replacement or valvular plasty surgery combined with radio frequency artial ablation between July 2011 and Feb 2012 in our department were included in this study.Patients were randomized into 2 groups:HTK group and conventional blood cardioplegia group.HTK group received single HTK solution antegrade perfusion for intraoperative myocardial protection,while conventional blood cardioplegia group received intermittent 1:4 blood-cardioplegia antegrade perfusion every 20min for intraoperative myocardial protection.Serial blood samples were obtained for detecting serum concentrations of cardiac troponin T(cTnT),creatine kinase(CK),MB isoenzyme of creatine kinase(CKMB) and MM isoenzyme of creatine kinase(CKMM).Data of clinical outcomes,such as post-operative mortality,complications,the incidence of arrhythmia,time of mechanical ventilation and ICU stay,cost of cardiopulmonary bypass,early post-operative life quality,were also recorded.Results The volume of HTK solution used was 1 922.2±399.3 ml for single perfusion,the total volume of blood cardioplegia was 2 837.3±249.6 ml,and the frequency was 3.06±0.72.There was no death in both groups.The most popular complication was peri-operative arrhythmia,and its occurrence was similar in both groups.There were no significant differences according to post operative ventilation time,ICU time and early post operative life quality between the two groups.The cardiopulmonary bypass cost was significantly higher in HTK group,although the serial post-operative serum concentrations of cTnT,CK,CKMB,CKMM were significantly decreased in HTK patients compared with blood cardioplegia patients at their corresponding time points.Conclusion Compared with intermittent antegrade blood cardioplegia,intra-operative myocardial

关 键 词：瓣膜置换 心房纤颤 射频消融 心肌保护 HTK液 含血停搏液 

分 类 号：R541.75[医药卫生—心血管疾病]