主动脉夹层手术中del Nido心脏停搏液与传统心脏停搏液心肌保护效果的比较  

Comparison of myocardial protective effect of del Nido cardioplegia with conventional cardioplegia in the procedure for aortic dissection

作　　者：鲍春荣[1] 梅举[1] 丁芳宝[1] 朱家全[1] 张俊文[1] 黄健兵[1] 马南[1] 许喜乐 张韫佼[1] BAO Chun-rong;MEI Ju;DING Fang-bao;ZHU Jia-quan;ZHANG Jun-wen;HUANG Jian-bing;MA Nan;XU Xi-le;ZHANG Yun-jiao(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092

出　　处：《中国心血管病研究》2020年第8期761-764,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的比较主动脉夹层手术中应用del Nido心脏停搏液和传统心脏停搏液的心肌保护效果.方法回顾性总结分析2017年7月至2019年12月上海交通大学医学院附属新华医院63例主动脉夹层手术的临床资料,根据应用的心脏停搏液不同分两组,应用del Nido心脏停搏液(DN组)33例,应用传统心脏停搏液(传统组)30例.DN组用del Nido晶体液与氧合血按4:1混合(4份晶体1份血),灌注量20 ml/kg,最大不超过1L.主动脉阻断时间超过90 min再次灌注300ml.传统组应用4:1含血冷晶体改良St.Thomas液(4份血1份晶体),灌注量15 ml/kg.每隔20~30 min灌注一次(7.5ml/kg).结果两组术前一般资料差异无统计学意义.术中体外循环时间、主动脉阻断时间传统组较长,但差异无统计学意义.停搏液灌注次数和灌注耗时传统组显著高于DN组.自动复搏率两组相近,DN组94%,传统组97%.术后早期(30天内)病死率DN组(6.1%)与传统组(6.7%)无差异.术后第1天血清肌钙蛋白ⅠDN组(4.10±0.65)ng/ml与传统组(4.25±0.61)ng/ml无差异.术后低心排发生率、术后1天和出院前LVEF两组之间差异均无统计学意义.结论主动脉夹层术中应用del Nido心脏停搏液可以达到满意的心肌保护效果.Objective To compare the myocardial protective effect of del Nido cardioplegia and conventional cardioplegia in procedure for aortic dissection.Methods The clinical data of 63 patients who underwent surgical procedure in our institution from Sep.2017 to Dec.2019 were retrospectively analyzed.The patients were divided into two groups according to different cardioplegia used,33 cases in the del Nido group and 30 cases in the conventional group.In the del Nido group,crystalloid del Nido cardioplegia mixed with oxygenized blood(4 crystalloid,I blood)20 ml/kg(no more than I L)was used as the first dosage.When the ascending aorta cross-clamp time was over 90 minutes,another dosage of 300 ml del Nido cardioplegia was used.In the conventional group,the modified St.Thomas cardioplegia mixed with oxygenized blood(4 blood,1 crystalloid)15 ml/kg was used as the first dosage.then after every 20 to 30 minutes another dosage of cardioplegia(7.5 ml/kg)was given.Results There was no difference in the preoperative data between 2 groups.The cardiopulmonary bypass time and aorta cross-clamp time of the conventional group were relatively longer than the DN group but no significant difference was found.The cardioplegia delivery time of DN group(6.06+1.92)min was significantly shorter than conventional group(13.87+4.78)min.The percentage of returning to sinus thythm spontaneously was similar in 2 groups(94%and 97%).Early mortality(within 30 days after surgery)was similar in 2 groups(6.1%and 6.7%).There was no difference of serum concentration of cardiac tropnin I(cTnI)between 2 groups[(4.10±0.65)ng/ml and(4.25±0.61)ng/ml].No dfference in the incidence of low cardiac output syndrome after surgery and the LVEF on the first postoperative day as well before dischange were found between two groups.Conclusion Del Nido cardioplegia can achieve excellent myocardial proective effect in the procedure for aortic dissection.

关 键 词：主动脉夹层 外科手术 心肌保护 DEL Nido心脏停搏液 

分 类 号：R654.2[医药卫生—外科学]