DavidⅠ术中顺行性与逆行性灌注del Nido心脏停搏液的心脏保护作用研究  

Antegrade versus retrograde del Nido cardioplegia in David I procedure

作　　者：张帅 韩昌秀 刘杨[1] 谷天祥[3] ZHANG Shuai;HAN Chang-xiu;LIU Yang;GU Tian-xiang(Pediatric Thoracic and General Surgery, Shengjing Hospital of China Medical University, Shenyang 110001, China;Cardiovascular Surgery, Affiliated Hospital of Hamhung Medical University, Democratic People's Republic of Korea;Cardiac Surgery, First Affiliated Hospital of China Medical University, Shenyang 110001, China)

机构地区：[1]中国医科大学附属盛京医院小儿普外胸外新生儿外科,辽宁省沈阳市110001 [2]朝鲜民主主义人民共和国咸兴医科大学附属医院心血管外科 [3]中国医科大学附属第一医院心脏外科

出　　处：《中国心血管病研究》2019年第9期813-817,共5页Chinese Journal of Cardiovascular Research

基　　金：国家重点研发计划重大慢性非传染性疾病防控研究重点专项(2017YFC1308000).

摘　　要：目的探讨David Ⅰ术中顺行性灌注与逆行性灌注del Nido心脏保护液的保护作用。方法回顾性分析我科于2014年6月至2018年1月行David Ⅰ手术的110例患者,患者早期行DavidI手术均为顺行性灌注组(2014年6月-2016年5月),后期为逆行性灌注组(2016年5月-2018年1月),比较两组临床后果,随访6-36个月。结果两组中均无临床死亡及再手术。体外循环时间、主动脉阻断时间比较未见统计学差异。两组中肌钙蛋白I水平、心肌酶谱、左心室射血分数、呼吸机辅助时间、监护室时间及住院天数均相似。顺行性灌注组中乳酸水平高于逆行性灌注组[(9.33±2.18)mmol/L比(7.22士1.44)mmol/L,P=0.018]。传导阻滞发生率在逆行性灌注组中(6例)高于顺行性灌注组(10.17%比1.96%,P=0.009),但仅有1例患者(1.69%)需要永久起搏器置入。结论在David Ⅰ手术中,顺行性和逆行性灌注del Nido心脏停搏液都是安全有效的。持续逆行性灌注del Nido心脏停搏液往往伴随着可接受的传导阻滞发生率及较低的乳酸水平。Objective T o investigate the effect of del Nido cardioplegia in DavidⅠprocedure on myocardial protection.Methods 110 patients undergoing David I operation with antegrade or retrograde del Nido solution from June 2014 to January 2018 were reviewed.T h e patients received DavidⅠoperation in early stage were enrolled into the antegrade group(June 2014-May 2016)and later were in the retrograde group(May 2016-January 2018).T h e clinical outcomes were compared.The follow-up was 6 month to 36 months.Results There was no hospital mortality or reoperation in both groups.Cardiopulmonary bypass and aortic clamp times were similar.Troponin I level,CKMB,left ventricle ejection fraction,ventilation times,intensive care unit and hospital stay times were similar between 2 groups.The lactate level was slightly higher[(9.33±2.I8)mmol/Lvs.(7.22±1.44)mmol/L,P=0.018]in antegrade group compared with retrograde group.The incidence rate of heart block w a s higher(6 patients)in retrograde group(10.17%vs.1.96%,P=0.009)and only 1 patient(1.69%)was required implantation of permanent cardiac pacemaker.Conclusion The antegrade and retrograde del Nidocardioplegia can be used safely and effectively in David 1 operation.The continuous retrograde del Nido cardioplegia is associated with acceptable morbidity of heart block and lower lactate level.

关 键 词：逆行性灌注心脏停搏液 DEL Nido心脏停搏液 David手术 心肌保护 

分 类 号：R654.2[医药卫生—外科学]