HTK液与温血灌注在成人瓣膜置换术中对心肌保护作用临床效果对比  

Comparison in clinical effect on myocardial protection between HTK solution and warm blood perfusion in adult valve replacement

作　　者：王丽芳[1] 周自强[1] 齐弘伟[1] 赵凤华[1] 吴明营[1] Wang Lifang;Zhou Ziqiang;Qi Hongwei;Zhao Fenghua;Wu Mingying(Cardiovascular Center,Beijing Tongren Hospital,Capital Medical University,Beijing 100176,China;不详)

机构地区：[1]首都医科大学附属北京同仁医院心血管中心,北京100176

出　　处：《中国循证心血管医学杂志》2020年第11期1341-1343,1356,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家食品药品监督管理总局资助项目(12011154)。

摘　　要：目的探讨成人瓣膜置换手术中使用不同心肌保护液(HTK液与温血灌注),对患者心肌保护作用的影响。方法选取2017年1月至2019年12月于首都医科大学附属北京同仁医院治疗心脏瓣膜置换术的患者30例,按照心肌保护方案不同分为HTK液组和温血灌注组,每组各15例。比较两组患者治疗情况、心肌相关指标及并发症的发生情况。结果两组患者术后血钾差异存在统计学意义,温血灌注可减少术后低钾。在对两组患者主动脉阻断后、开放后、术后第1 d、第3 d、第7 d等五个时间点对肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、缺血修饰白蛋白(IMA)水平检测,发现两组心肌指标的组间、时间及交互效应均具有统计学差异。温血灌注组主动脉阻断后、主动脉开放后TMA,术后第1 d、术后第3 d、术后第7 d CK-MB,主动脉阻断后、主动脉开放后、术后第1 d、术后第3 d、术后第7 d cTn-T优于HTK液组。结论HTK液与温血灌注在成人瓣膜置换术均有一定的心肌保护作用,温血灌注对心脏缺氧缺血的损害较轻,具有更好的心肌保护效果。Objective To discuss the influence of different myocardial protection solution(HTK solution and warm blood perfusion)on protective effect in patients during valve replacement.Methods The patients undergone valve replacement(n=30)were chosen from Beijing Tongren Hospital affiliated to Capital Medical University from Jan.2017 to Dec.2019,and divided,according to different heart protection plans,into HTK solution group and warm blood perfusion group(each n=15).The therapeutic situation,myocardial-related indexes and complication incidence were compared between 2 groups.Results The cases of postoperative kaliopenia decreased in warm blood perfusion group with statistical significance.The detections on levels of creatine kinase-MB isoenzyme(CKMB),cardiac troponin T(cTnT)and ischemia modified albumin(IMA)showed that there was statistical difference between 2 groups,at time and in interaction effects at 5 time points including after aortic occlusion,after aortic opening and the 1th d,3rd d and 7th d after operation.IMA after aortic occlusion and after aortic opening,CKMB on the 1th d,3rd d and 7th d after operation,and cTn-T at 5 time points were superior in warm blood perfusion group to those in HTK solution group.Conclusion HTK solution and warm blood perfusion all have some myocardial protection effects,while warm blood perfusion has a better myocardial protective effect with less damage of hypoxia and ischemia during valve replacement.

关 键 词：HTK液 温血灌注 瓣膜置换术 心肌保护 缺血修饰白蛋白 肌酸激酶同工酶 心肌肌钙蛋白T 

分 类 号：R542.5[医药卫生—心血管疾病]