Del Nido心脏停搏液在成人瓣膜置换术中的应用和疗效分析  被引量:13

Application and effect of Del Nido cardioplegia in adult valve replacement surgery

在线阅读下载全文

作  者:张开天 曹勇 刘超 曹永科 何勇 陈凯明 陈波 王茂生 Zhang Kaitian;Cao Yong;Liu Chao;Cao Yongke;He Yong;Chen Kaiming;Chen Bo;Wang Maosheng(Department of Cardiovascular Surgery,The People's Hospital of Gaozhou,Gaozhou 525200,China)

机构地区:[1]广东医科大学附属高州医院高州市人民医院心血管外科,高州525200

出  处:《中国体外循环杂志》2018年第4期200-205,共6页Chinese Journal of Extracorporeal Circulation

基  金:广东省卫计委医学科学技术研究基金项目(A2017436)

摘  要:目的以国内外目前应用广泛的改良St.Thomas停搏液(STH液)为标准,对比分析Del Nido停搏液(DN液)在成人瓣膜手术中的应用和疗效。方法本研究为前瞻性随机对照研究。收集高州医院在2016年7月至2017年5月的连续病例,均为同期需在同一手术小组常规体外循环(CPB)下行瓣膜置换术的患者,年龄在18岁至65岁之间,共178例患者可纳入研究。患者随机分为DN组(n=92例)和STH组(n=86例),心肌保护分别采用DN液和STH液灌注,常规完成心脏瓣膜手术,分别于术前、术后6 h、术后第1天、术后第6天4个时点,测定心肌肌钙蛋白I(c Tn I)的水平,并收集患者围手术期的其他临床指标,比较两组围手术期各指标的差别。结果 DN组平均灌注次数及灌注剂量均较STH组少,但并不增加术中心脏自发性收缩发生率(2.2%vs 3.5%,P=0.596),可缩短主动脉阻断(ACC)时间及CPB时间,分别为(61.74±25.23)min vs(69.91±27.14)min,P<0.05和(91.98±42.60)min vs(100.23±31.38)min,P<0.05。与STH组的c Tn I峰值相比,DN组c Tn I的释放量在较低水平,分别为(8.12±4.33)μg/L和(11.03±6.33)μg/L,P<0.001;相关回归分析示:两组c Tn I峰值与ACC时间均无相关(P>0.05)。两组手术死亡、术后其他相关临床指标及相关并发症发生率差别无统计学意义(P>0.05)。结论 DN液管理简便,可提供稳定的心脏停搏,在成人瓣膜置换手术应用中,近期疗效良好,心肌保护效果较常规STH液更为优越,未见明显相关禁忌。Objective To evaluate the safety and efficacy of Del Nido cardioplegia( DN cardioplegia) during adult valvular surgery compared with modified St.Thomas cardioplegia( STH cardioplegia),which has been widely used at home and abroad. Methods This study was a prospective randomized controlled study.The clinical data of 178 patients undergoing valve replacement operation in Gaozhou Hospital from July 2016 to May 2017 were retrospectively collected. Among them,92 patients were randomly divided in to DN group while the rest 86 patients were assigned to STH group,using DN cardioplegia or STH cardioplegia in operations retrospectively. All of them underwent surgery in routine cardiopulmonary bypass( CPB) by a same surgical group in Gaozhou Hospital. Blood samples before operation,6 hours after operation,first and sixth day after operation were collected and levels of cardiac troponin I( c Tn I)were detected. Finally,relationships between the expression of c Tn I and patients’ other clinical features were analyzed in detail. Results DN group had less mean infusion times and lower perfusion dose than STH group,but it did not increase spontaneous contraction of heart during surgery significantly( the ratio was 2. 2% vs 3. 5%,P = 0. 596). DN solution could significantly shorten the aortic cross clamp( ACC) time( P 〈0.05). The release peak of c Tn I was significant lower in DN group than that in STH group( 8.12±4.33 μg/L vs 11.03±6.33 μg/L,P 〈0.001). The related and regression analysis showed that there were no obvious correlations between the release peak level of c Tn I and the ACC time within the stipulated time of the two groups( P 〉 0.05). There were no significant differences between the two groups in the operative mortality rate,other related clinical indexes and related complication rate( P 〉0.05).Conclusion Del Nido cardioplegia performs well in achieving heart arrest. It is easy to manage with good short-term effects in adult valve surgery. The myocardial protecti

关 键 词:DEL Nido心脏停搏液 St.Thomas心脏停搏液 心肌保护 体外循环 

分 类 号:R654.2[医药卫生—外科学]

 

参考文献:

正在载入数据...

 

二级参考文献:

正在载入数据...

 

耦合文献:

正在载入数据...

 

引证文献:

正在载入数据...

 

二级引证文献:

正在载入数据...

 

同被引文献:

正在载入数据...

 

相关期刊文献:

正在载入数据...

相关的主题
相关的作者对象
相关的机构对象