康斯特保护液与含血停搏液在David及全弓置换支架象鼻手术中心肌保护的临床效果  

Cardioprotective effects of HTK solution and conventional blood cardioplegia in patients with aortic dissection undergoing David and total arch replacement combined with stented elephant trunk implantation

作　　者：仇冰梅 孙磊 张雷 张晓华 王常田 吴海卫 周志强 申翼 李德闽 Qiu Bingmei;Sun Lei;Zhang Lei;Zhang Xiaohua;Wang Changtian;Wu Haiwei;Zhou Zhiqiang;Shen Yi;Li Demin(Department of Cardiothoracic Surgery, Jinling Hospital, Clinical Medical School of Nanjing University, Jiangsu Nanjing 210002, China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)心胸外科,南京210002 [2]南京大学医学院附属金陵医院(东部战区总医院)麻醉科,南京210002

出　　处：《中国体外循环杂志》2019年第2期76-80,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨康斯特保护液(HTK液)与含血停搏液在深低温停循环(DHCA)下行David手术及全弓置换支架象鼻手术中心肌保护的临床效果。方法回顾性分析2016年1月至2018年11月在本院行该手术的38例患者,按其心肌保护时采用不同的灌注液分为两组:HTK液组(n=19)和4∶1含血心脏停搏液组(n=19)。分别收集术前(T1)、开放升主动脉后10 min(T2)、术后24 h(T3)、术后48 h(T4)心肌酶谱肌酸激酶(CK)、血清肌钙蛋白I(c Tn I)、心肌型肌酸激酶同工酶(CKMB)浓度,术后机械通气时间、ICU时间,术后并发症及预后等情况。结果两组围术期各2例患者出现死亡,其中2例死于多脏器功能衰竭,1例死于神经系统并发症,1例死于继发腹主动脉破裂出血。含血停搏液和HTK液两组转机时间、阻断时间、停循环时间无统计学差异,停搏液用量两组有差异。两组患者血液心肌酶谱浓度在升主动脉开放后及术后24 h均显著升高(P <0.01),术后48 h开始呈下降趋势,CK浓度在T2、T4时间点HTK液组显著低于含血停搏液组(P <0.05),CKMB浓度在T3时间点HTK液组显著低于含血停搏液组(P <0.05),cTnI浓度在T3、T4时间点HTK液组显著低于含血停搏液组(P <0.01,P <0.05),两组患者费用有差异(P <0.01)。结论两种心肌保护液都具有较好的心肌保护作用,CK浓度在T2、T4时间点、CKMB浓度在T3时间点、c Tn I浓度在T3、T4时间点HTK液组显著低于含血停搏液组(P <0.05),从心肌酶谱数值上其心肌保护效果优于含血停搏液组。Objective To compare the cardioprotective effects and clinical outcomes of HTK solution and conventional blood cardioplegia in patients with aortic dissection undergoing David and total arch replacement combined with stented elephant trunk implantation under DHCA. Methods From January 2016 to November 2018,data of 38 patients in our department undergoing the surgery were reviewed. Patients were divided into HTK group( n = 19) and 4: 1 conventional blood cardioplegia group( n = 19) according to different cardioplegia and myocardial perfusion methods. Serial blood samples were collected for detection of serum concentrations of creatine kinase( CK),cardiac troponin I( c Tn I),MB isoenzyme of creatine kinase( CKMB). Data of clinical outcomes including postoperative mortality,complications,ICU stay,postoperative complications and prognosis were also recorded. Results There were two deaths in each group during perioperative period. Among them,two patients died of multiple organ failure,one patient died of neurological complications,one died of secondary abdominal aotic rupture hemorrhage. There was no statistical difference in the duration of CPB time,aortic cross clamp time,and deep hypothermic circulatory arrest time. The solusion volume and perfusion frequency of cardioplegia in two groups showed significant difference. Serum myocardial enzymes in both groups increased significantly after opening of the aorta and 24 hours after the operation( P <0.01),but began to decrease at 48 hours postoperatively. The concentration of CK in HTK group was significantly lower than that in blood cardioplegia group at T2 and T4( P <0.05),and the concentration of CKMB in HTK group was significantly lower than that in blood cardioplegia group at T3( P <0.05). At T3 and T4,the concentration of c Tn I in HTK group was significantly lower than that in blood cardioplegia group( P <0.01,P <0.05). Costs of the two groups were significantly different( P <0.01). There was no significant difference in quality of life between the two groups aft

关 键 词：深低温停循环 主动脉夹层 David手术 全弓置换支架象鼻术 心肌保护 HTK液 含血停搏液 

分 类 号：R654.2[医药卫生—外科学]