改良del Nido停搏液在成人腔镜下二尖瓣瓣膜置换手术中的应用  被引量:7

Application of modified del Nido cardioplegia in thoracoscopic mitral valve replacement in adults

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作  者:李帆[1] 胡振飞[1] 詹海婷[1] 黄一丹[1] 吴建江[1] 苟伟挺 吴鹏凯 Li Fan;Hu Zhenfei;Zhan Haiting;Huang Yidan;Gou Weiting;Wu Pengkai(Department of Anesthesiology,The First Affiliated Hospital of Xinjiang Medical University,Xinjiang Medical University,Urumchi 830000,China)

机构地区:[1]新疆医科大学第一附属医院麻醉科,乌鲁木齐830000

出  处:《中国体外循环杂志》2020年第4期216-220,共5页Chinese Journal of Extracorporeal Circulation

基  金:新疆维吾尔自治区重点实验室开放课题(2019D04019)。

摘  要:目的比较改良del Nido停搏液与改良St.Thomas停搏液在成人腔镜下二尖瓣瓣膜置换手术中的初步临床效果。方法收集2018年2月至2019年5月在本院胸腔镜下行二尖瓣置换术的74例二尖瓣瓣膜疾病成年患者,男性39例,女性35例,年龄18~68岁。随机分为del Nido停搏液组(DNC)和St.Thomas停搏液组(STH)。采集并记录术前(T0)、术后1 h(T1)、术后24 h(T2)血中的心肌相关因子[肌钙蛋白,心肌型肌酸激酶同工酶(CKMB)]的浓度,记录体外循环时间,停搏液灌注次数及停搏液总量:观察并记录术后24 h正性肌力药物使用情况、术后ICU呼吸机辅助时间、ICU的滞留时间。结果两组患者年龄、体重、性别、射血分数、血肌酐、术后ICU呼吸机辅助时间以及术后24 h正性肌力药物使用情况等组间均无显著差异(P>0.05)。与STH组相比,DNC组灌注停搏液的总量、灌注次数、体外循环时间均减少,具有统计学差异(P<0.05),术后CKMB降低(P<0.05)。结论单次灌注del Nido停搏液在成人腔镜瓣膜手术中安全,并且可以缩短体外循环时间。Objective To compare the preliminary clinical effects of modified del Nido cardioplegia and modified St.Thomas’cardioplegia in adult thoracoscopic mitral valve replacement.Methods From February 2016 to December 2017,74 patients with mitral valve diseases underwent thoracoscopic mitral valve replacement in our hospital,including 49 males and 35 females,aged from 18 to 68 years.The concentrations of myocardial related factors[troponin,myocardial creatine kinase isoenzyme(CKMB)in blood at 1 h(T1)and 24 h(T2)after operation],aortic occlusion time,cardiopulmonary bypass time,cardioplegia perfusion times and total cardioplegia dosage were observed and recorded:the clinical automatic pulsatile rate,the score of positive drugs during cardiopulmonary bypass,the amount of blood transfusion,the use of positive inotropics 24 h after operation,the time of mechanical ventilation and ICU stay were observed and recorded.Results There were no significant differences in age,weight,sex,ejection fraction,postoperative myocardial injury,Serum creatinine levels,postoperative ICU ventilator assistant time and the use of positive inotropic drugs 24 h after surgery between two groups(P>0.05).Compared with the STH group,the total volume of cardioplegia,the perfusion times and the extracorporeal circulation time of the DNC group were lower(P<0.05).Conclusion Single infusion of del Nido cardioplegia is safe in adult thoracoscopic valvular surgery and can shorten the time of extracorporeal circulation.

关 键 词:心肌保护 del Nido心肌保护液 成人 腔镜手术 二尖瓣置换术 体外循环 

分 类 号:R654.2[医药卫生—外科学]

 

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