HTK保护液与含血晶体液在大血管转位术中的临床应用研究  

Clinical research of HTK solution and blood cardioplegia in arterial Switch operation

作　　者：沈佳[1] 张蔚[1] 姜磊[1] 唐嘉忠[1] 朱德明[1] SHEN Jia;ZHANG Wei;JIANG Lei;TANG Jia-zhong;ZHU De-ming(Department of Cardiopulmonary Bypass,Department of Cardiothoracic Surgery,Shanghai Children's Medical Center,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科体外循环科,200129

出　　处：《中华临床医师杂志（电子版）》2012年第22期7126-7129,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的比较HTK液和含血晶体液在大血管转位术中的心肌保护效果。方法回顾2011年3～12月,60例分别应用HTK液(实验组)和含血晶体液(对照组)为心肌保护液,行大血管转位术(Switch术)的病例,每组各30例。对术中保护液灌注方式、心肌保护效果、术后心功能恢复情况进行分析,于术后24h采血检测血清肌钙蛋白I(cTnI)、脑利钠肽(BNP)含量。记录心脏自动复跳率,术后插管时间及监护室时间等指标。结果两组术后早期死亡分别为HTK组1例,对照组2例,体外循环时间无差异。HTK液组主动脉阻断时间较短,为(89.67±22.28)min(P=0.004),均灌注一次,保护液用量51.73ml/kg,停跳效果好,术中无需再行冠状动脉内灌注,自动复跳率100%,术后血清cTnI(P=0.032)和正性肌力药物评分(P=0.018)均低于对照组。结论 HTK心肌保护液较含血晶体保护液更适用于未成熟心肌;心肌保护时间长、避免冠状动脉内灌注的特点,更适合于Switch手术。Objective To compare the cardioprotective effect of HTK solution and blood cardioplegia in Switch operation.Methods From 2011.3 to 2011.12,60 patients of Switch operation were enrolled,who were used HTK solution(30 cases)and blood cardioplegia(30 cases).The delivery method was evaluated,and the effect of myocardium protection and the post-operative cardiac function were investigated.The serum cTnI and BNP at 24 hours after surgery were measured,and the spontaneous normal rhythm recovery rate with other ICU information was recorded.Results The early post-operative mortality was 1 patient of HTK group and 2 patients of blood cardioplegia group.No difference in CPB time.In HTK group,the average aortic arrest time was shorter[(89.67±22.28)min,P=0.004],and all the patients delivered only once cardioplegia with average dose of 51.73 ml/kg HTK solution.No patient needed more intra-coronary infusion,and the spontaneous normal rhythm recovery rate was 100%.Postoperative cTnI concentration and the IS score in the ICU were lower than those in the blood cardioplegia group.Conclusions HTK solution is appropriate suitable for immature myocardium protection compared with the blood cardioplegia.The characters of long protection time and avoiding intra-coronary infusion are superior to other cardioplegiaes for Switch operation.

关 键 词：大血管转位术 心肌保护 HTK 液 

分 类 号：R654.2[医药卫生—外科学]