HTK液心肌保护作用的临床研究  

Protective effect of HTK solution on cardiac muscle

作　　者：王文涛[1] 谢贞波[1] 王骏[1] 李海针[2] 范全心[3] 

机构地区：[1]武警湖北总队医院心胸外科,武汉市430061 [2]武警北京总队第二医院麻醉科,100081 [3]山东省立医院心脏外科,济南市250021

出　　处：《实用医学杂志》2007年第1期47-50,共4页The Journal of Practical Medicine

摘　　要：目的:通过对比3种心脏停搏液在风湿性心脏病患者瓣膜置换术中心肌保护的效果,初步评价HTK停搏液的心肌保护作用。方法:将36例因风湿性心脏病接受瓣膜置换术的患者随机分为3组(n=12),分别用St·ThomasⅡ液(A组)、4∶1冷含血停搏液(B组)、HTK液(C组)灌注停跳。于麻醉诱导后、升主动脉开放或心内主要操作完成后5min,术后2、6、12、24、48和72h分别采血检测血清肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)及肌红蛋白(MYO)含量的变化;记录心脏自动复跳率、心律失常发生率、术后正性肌力药物用量、呼吸机支持时间和ICU治疗时间等临床指标;电镜观察心肌细胞超微结构。结果:术后B、C两组血清cTnT(主动脉阻断后5min及术后48、72h除外)、CK-MB(主动脉阻断后5min、术后2h)含量均显著低于A组(P<0.05或P<0.01);两组术后正性肌力药物用量、呼吸机支持时间和ICU治疗时间等临床指标均显著优于A组(P<0.05);两组心肌细胞超微结构的变化显著优于A组(P<0.05),B、C两组比较差异无显著性(P>0.05)。结论:HTK液在瓣膜置换术中具有较好的心肌保护作用。Objective To evaluate the effect of HTK solution on myocardial protection during valve replacement surgery by comparing it with the other two cardioplegie solutions. Methods Thirty-slx patients with rheumatic heart disease were randomized to receive St,Thomas Ⅱ （group A,n=12）, 4：1 cold blood （group B,n=12）, or HTK （group C,n=12） cardioplegic solution during valve replacement. Serum levels of cardiac troponin T （cTnT）, creatine kinase MB （CK-MB） and myoglobin （MYO） were measured immediately after induction of anesthesia, 5 rain, 2 h, 6 h, 12 h, 24 h, 48 h and 72 h following the end aortic declamping or intra-cardiac manipulation. The clinical parameters including the auto-beating rate, incidence of cardiac arrhythmia, inotropic support, duration of mechanical ventilation, and length of stay in the intensive care unit were documented. The myocardial ultrastructure was observed by electron microsopy. Results Serum levels of cTnT and CK-MB were significant lower in groups B and C than in group A （P〈0.05 or P〈0.01）. A lower incidence of cardial arrhythmia oceurred in groups B and C. Inotropic support, duration of mechanical ventilation and length of stay in the intensive care unit were shorter in groups B and C （P 〈 0.05）. The changes in cellular ultrastructure in groups B and C were superior to those in group A （P 〈 0.05）, there was no significant difference between group B and C （P 〉 0.05）. Conclusion HTK cardioplegic solution is value for myocardial protection during valve replacement.

关 键 词：风湿性心脏病 体外循环 心脏停搏液 心肌保护 

分 类 号：R654.2[医药卫生—外科学]