康斯特保护液对婴幼儿法洛四联症根治手术心肌保护作用的临床研究  

Myocardial protection study of histidine-tryptophan-ketoglutarate cardioplegic solution on infants with tetralogy Hnang

作　　者：黄建成[1] 闫芳[1] 崔晓征[1] 王军[1] 张会军[1] 李志杰[1] 董彦博[1] 

机构地区：[1]河北医科大学第一医院心外科,石家庄050031

出　　处：《中国综合临床》2015年第5期451-454,共4页Clinical Medicine of China

摘　　要：目的探讨康斯特保护液（HTK液）在婴幼儿法洛四联症根治手术中心肌保护效果，评估康斯特保护液对缺氧型婴幼儿心内直视手术中心肌的保护作用。方法将40例年龄7～35个月、体质量5．3～9．5kg的法洛四联症患儿，随机分为HTK组和St．ThomasⅡ停搏液（STH液）组，每组各20例。麻醉后在主动脉根部分别灌注HTK液以及STH液。分别在升主动脉开放后1、2、4、8、24、48h采血3ml，生化法检测血浆肌钙蛋白I（cTnI）、肌酸激酶（CK）和肌酸激酶同工酶（CK—MB）浓度变化。结果两组患儿不同时间点血浆cTnI浓度比较差异有统计学意义（F组内=49．94、P〈0．001，F组间=10．23、P〈0．001，F交互=28．49、P〈0．001）；升主动脉开放后1、2、4、8、24、48h，HTK组均低于STH组，组间比较差异均有统计学意义（P均〈0．05）。两组患儿不同时间点血浆CK浓度比较差异有统计学意义（F组内=58．82、P〈0．001，F组间=16．43、P〈0．001，F交互=18．32、P〈0．001）；升主动脉开放后1、2、4、8、24、48h，HTK组均低于STH组，组间比较差异均有统计学意义（P均〈0．05）。两组患儿不同时间点血浆CK．MB浓度比较差异有统计学意义（F组内=34．51、P〈0．001，F组间=11．03、P〈0．001，F交互=10．28、P〈0．001）；升主动脉开放后1、2、4、8、24、48h，HTK组均低于STH组，组间比较差异均有统计学意义（P均〈0．05）。结论法洛四联症心内直视手术中，主动脉根部灌注HTK液较STH液可明显提高心肌抗缺血能力，增强心功能，降低心率失常，降低缺血再灌注损伤。Objective To evaluate the myocardial protective effects of Histidine-Tryptophan- Ketoglutarate （HTK） solution on infants with tetralogy of fallot in cardiac operation through comparison with St. Thomas Ⅱ cardioplegia（STH） and HTK eardioplegia in the operation of tetralogy of fallot. Methods Forty infants with tetralogy of fallot（TOF） were enrolled in this study. Their age ranged from 7 to 35 months ,and body mass from 5.3 to 9. 5 kg. The infants were randomly divided into HTK （ n = 20） group and STH （ n = 20） group who received HTK or STH solution respectively. Then 3 ml blood sample were got at 1,2,4,8,24 and 48 h after the opening of ascending aorta. The serum levels of cardiac troponin Ⅰ（cTnI） ,ereatine kinase（CK） and creatine kinase MB（CK-MB） were measured. Results There was significant difference between two groups in terms of the level of eTnI at different time （ F （ inner group ） = 49. 94, P〈 0.001 ; F （ between group ） = 10. 23, P〈 0. 001 ; F （across group）= 28.49,P〈0. 001 ） , and the level of cTnI in HTK group was lower than that of STH group at 1, 2,4,8,24 and 48 h after the opening of ascending aorta（ P〈0. 05）. There was significant difference between two groups in terms of the level of CK at different time （F（ inner group）= 58.85, P〈 0. 001;F（ between group） = 16.43, P〈0. 001 ;F（ across group）= 18.32, P〈0. 001 ） , and the level of CK in HTK group was lower than that of STH group at 1,2,4,8,24 and 48 h after the opening of ascending aorta （P〈0. 05 ）. There was significant difference between two groups in terms of the level of CK-MB at different time （F（ inner group）= 34. 51, P 〈0. 001 ;F（between group）= 11.03 ,P〈0. 001 ;F（ across group）= 10. 28 ,P〈0. 001 ） ,and the level of CK-MB in HTK group was lower than that of STH group at 1,2,4,8,24 and 48 h after the opening of ascending aorta （ P 〈0. 05）. Conclusion HTK is more valid than STK for improving the ability of anti ischemia of myoca

关 键 词：康斯特保护液 St.ThomasⅡ停搏液 法洛四联症 肌钙蛋白Ⅰ 肌酸激酶 肌酸激酶同工酶 

分 类 号：R654.2[医药卫生—外科学]