Del Nido心脏停搏液在成人联合瓣膜手术中的临床研究  

Del Nido cardioplegia in adult combined valvular surgery: a clinical cohort study

作　　者：邹华西 黄文雄[1] 周学亮[1] 黄璜[1] 黎扬 吴起才[1] ZOU Huaxi;HUANG Wenxiong;ZHOU Xueliang(Department of Cardiovascular Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 3*30006 China)

机构地区：[1]南昌大学第一附属医院心脏大血管外科,南昌330006

出　　处：《江西医药》2020年第4期366-369,400,共5页Jiangxi Medical Journal

基　　金：江西省卫生健康委科技计划项目,编号20204099。

摘　　要：目的比较Del Nido心脏停搏液(DN液)与改良St.Thomas心脏停搏液(MST液)在成人联合瓣膜手术中的心肌保护效果及临床结果。方法选取2018年3月-2019年2月在我院行联合瓣膜手术的119例成年患者,分为MST组(n=56)与DN组(n=63)两组,分别采用MST液和DN液作为心脏停搏液。于术前(T1)、术后24 h(T2)、术后48h(T3)这3个时间点检测心肌损伤标志物及炎性因子等生化指标的浓度,并比较体外循环时间,主动脉阻断时间,复跳后除颤率,并发症发生率等相关围术期临床资料。结果所有患者均顺利完成手术,其中双瓣置换术107台,主动脉瓣置换+二尖瓣成形术12台。DN组较之MST组,其体外循环时间及主动脉阻断时间缩短,灌注次数减少,自动复跳率高,同时术后胰岛素使用率低于MST组,差异具有统计学意义(P<0.05),而机械通气时间、正性肌力药物使用时间、ICU停留时间、并发症的发生率、各时间点的生化指标等均无显著差异(P>0.05)。结论DN液应用于成人联合瓣膜手术,在简化灌注操作的同时提供良好的心肌保护能力,且具有缩短体外循环时间、提高自动复跳率及优化术后血糖控制等优势。Objective To compare the intraoperative application, myocardial protection and clinical results of Del Nido cardioplegia and Modified St. Thomas cardioplegia in adult combined valvular surgery. Methods 119 consecutive adult patients undergoing combined valvular surgery in our hospital from March 2018 to February 2019 were selected and divided into Modified St.Thomas cardioplegia group(n=56) and Del Nido cardioplegia group(n=63). Different cardioplegia were used respectively during the operation. The concentrations of biochemical indexes like c Tn-I(cardiac troponin I), CK-MB(creatine kinase-MB), IL-6(interleukin-6), TNF-α(tumor necrosis factor-α) were detected at preoperative(T1), postoperative 24 hours(T2), and postoperative 48 hours(T3), and the perioperative clinical data of cardiopulmonary bypass time, aortic cross clamping time, defibrillation rate, and incidence of complications were compared. Results All patients completed the operation successfully. The cardiopulmonary bypass time(133.2±18.34 vs 140.9±21.72 minutes), aortic cross clamping time(92.7±12.38 vs 97.5±13.03 minutes), perfusion frequency(1.1±0.36 vs 2.9±0.53), defibrillation rate(11% vs 28%) and postoperative insulin usage(38% vs 64%) were significantly lower in the Del Nido cardioplegia group than in the Modified St. Thomas cardioplegia group(P<0.05).However, there were no significant differences in mechanical ventilation time, inotropic usage, ICU residence time, incidence of complications and biochemical indexes at each time point(P>0.05). Conclusion Del Nido cardioplegia can be safely and effectively used in adult combined valvular surgery, providing myocardial protection at least equivalent to Modified St. Thomas cardioplegia while simplifying the perfusion operation, and may have advantages such as shortening extracorporeal circulation time, bring high rate of spontaneous return of sinus rhythm and contribute to better postoperative blood glucose control.

关 键 词：DEL Nido心脏停搏液 联合瓣膜病 体外循环 心肌保护 

分 类 号：R654.2[医药卫生—外科学]