del Nido心脏停搏液在成人冠状动脉旁路移植联合瓣膜置换手术中的安全性  

Safety of del Nido cardioplegia in coronary artery bypass grafting combined with heart valve replacement in adults

作　　者：姜秀丽[1] 顾天玉[1] 刘麟[1] 宋杰[1] 周小宇 郭震 Jiang Xiuli;Gu Tianyu;Liu Lin;Song Jie;Zhou Xiaoyu;Guo Zhen(Deartment of Anesthesiology,the 2nd Affiliated Hosital of Nantong University,Nantong 226001,China;Deartment of Extracororeal Circulation,Shanghai Chest Hospital,Shanghai 200030,China)

机构地区：[1]南通大学第二附属医院麻醉科,南通226001 [2]上海市胸科医院体外循环室,上海200030

出　　处：《中华医学杂志》2019年第48期3770-3774,共5页National Medical Journal of China

基　　金：江苏省卫生和计划生育委员会面上项目(H2017055)。

摘　　要：目的探讨del Nido心脏停搏液在成人冠状动脉旁路移植联合心脏瓣膜置换手术中的安全性和心肌保护效果。方法选择2018年4月至2019年4月于南通大学第二附属医院及上海市胸科医院择期行体外循环下冠状动脉旁路移植联合心脏瓣膜置换患者84例,男22例,女62例,采用随机数字表法分为del Nido心脏停搏液组(44例)或Thomas心脏停搏液组(40例)。分别测定麻醉诱导前肌钙蛋白,以及体外循环终止后2、12、24 h的肌钙蛋白浓度。结果两组患者年龄、性别、基础疾病、体表面积等差异均无统计学意义(均P>0.05)。手术中心脏停搏液灌注次数对比,del Nido组少于Thomas组(P<0.05)。Thomas组患者在体外循环12 h[(4.59±0.76)μg/L比(2.20±0.53)μg/L,t=-16.653,P<0.001]、24 h[(6.70±0.97)μg/L比(1.96±0.58)μg/L,t=-26.975,P<0.001]肌钙蛋白浓度高于del Nido组。两组患者术后恢复自主节律(P=0.887)、除颤(P=0.880)、正性肌力药物使用(P=0.163)比例和左室射血分数(P=0.338)差异均无统计学意义。结论在成人冠状动脉旁路移植联合心脏瓣膜置换手术中使用del Nido心脏停搏液是安全的,能减少心脏停搏液灌注次数,简化手术流程。肌钙蛋白的变化趋势提示del Nido停搏液具有更好的心肌保护作用。Objective To investigate the safety and myocardial protective effect of del Nido cardioplegia in coronary artery bypass grafting combined with heart valve replacement in adults.Methods From April 2018 to April 2019,84 patients undergoing coronary artery bypass grafting combined with heart valve replacement under cardiopulmonary bypass(CPB)in the Second Affiliated Hospital of Nantong University and Shanghai Chest Hospital were selected,and divided into del Nido cardioplegia(n=44)group and Thomas cardioplegia(n=40)group using a random number table.The concentration of troponin was measured before anesthesia induction and 2,12 and 24 hours after the termination of CPB,respectively.Results The preoperative characteristics of each group were similar,including age,underlying diseases,and body surface area(all P>0.05).The frequency of intraoperative cardioplegia infusion in the del Nido group was significantly lower than that in the Thomas group(P=0.03).Compared with the del Nido group,troponin concentration in the Thomas group increased significantly at 12 hours[(4.59±0.76)μg/L vs(2.20±0.53)μg/L,t=-16.653,P<0.001]and 24 hours[(6.70±0.97)μg/L vs(1.96±0.58)μg/L,t=-26.975,P<0.001]after CPB.No statistically significant differences were found in the postoperative recovery of cardiac autonomic rhythm(P=0.887),cardiac defibrillation(P=0.880),positive inotropic drugs(P=0.163)and left ventricular ejection fraction(P=0.338)between the two groups.Conclusions It is safe to use del Nido cardioplegia in coronary artery bypass grafting combined with heart valve replacement in adults,which can reduce the frequency of cardioplegia infusion and simplify the surgical procedure.The trend of troponin concentration suggests that del Nido cardioplegia has a better myocardial protective effect.

关 键 词：冠状动脉分流术 血液灌注 体外循环 

分 类 号：R65[医药卫生—外科学]