del Nido心肌保护液联合自体血逆行预充技术在成人联合瓣膜心脏手术中应用价值  

Application of del Nido cardiopregia combined with retrograde autologous blood priming in adult combined cardiac valve surgery

作　　者：钱晓亮[1] 陈月 赵惠 黄佳鑫[1] 孟凡伟[1] 葛振伟[4] 李建朝[1] 杨雷一[1] 程兆云[4] 夏爱娟 QIAN Xiao-liang;CHEN Yue;ZHAO Hui;HUANG Jia-xin;MENG Fan-wei;GE Zhen-wei;LI Jian-chao;YANG Lei-yi;CHENG Zhao-yun;XIA Ai-juan(Department of Extracorporeal Circulation,Heart Center of Henan Provincial People’s Hospital,Central China Fuvuai Hospital,Central China Fuvuai Hospital of Zhengzhou University,Zhengzhou,Henan 451464,China;Department of Anesthesiology,Henan Provincial People’s Hospital,Zhengzhou University People’s Hospital,Zhengzhou,Henan 450003,China;Department of Cardiac Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Cardiovascular Surgery,Heart Center of Henan Provincial People’s Hospital,Central China Fuvuai Hospital,Central China Fuvuai Hospital of Zhengzhou University,Zhengzhou,Henan 451464,China)

机构地区：[1]河南省人民医院心脏中心,华中阜外医院体外循环科郑州大学华中阜外医院,河南郑洲451464 [2]河南省人民医院麻醉科,郑州大学人民医院,河南郑州450003 [3]复旦大学附属中山医院心外科,上海200032 [4]河南省人民医院心脏中心,华中阜外医院心血管外科,郑州大学华中阜外医院,河南郑州451464

出　　处：《中华实用诊断与治疗杂志》2021年第8期828-830,共3页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划省部共建项目(20190796)。

摘　　要：目的探讨在成人联合瓣膜心脏手术中应用del Nido心肌保护液联合自体血逆行预充技术的可行性及应用效果。方法行主动脉瓣联合二尖瓣置换手术患者60例,其中采用del Nido心肌保护液联合自体血逆行预充技术进行体外循环操作管理的患者30例为观察组,采用del Nido心肌保护液联合常规预充技术进行体外循环操作管理的患者30例为对照组。记录2组主动脉阻断时间、体外循环时间、心肌保护液的灌注次数和总量、自动复跳率、体外循环中最低血红蛋白水平、撤机时血红蛋白水平、超滤使用情况等指标。结果观察组术中最低血红蛋白水平[(95.4±3.1)g/L]、撤机时血红蛋白水平[(108.1±5.4)g/L]均高于对照组[(74.2±5.9)、(92.2±8.5)g/L](P<0.05),超滤使用率(53.3%)低于对照组(93.3%)(P<0.05);2组患者体外循环时间、主动脉阻断时间、后并行辅助时间、手术时间、心脏自动复跳率、心肌保护液灌注次数、心肌保护液灌注总量、术前血红蛋白水平、术后第1天引流量、气管插管带管时间、术后ICU停留时间比较差异均无统计学意义(P>0.05)。结论成人联合瓣膜心脏手术中应用del Nido心肌保护液联合自体血逆行预充技术可减轻血液稀释,降低超滤使用率,提高撤机时血红蛋白水平,有利于患者转归。Objective To investigate the feasibility of del Nido cardiopregia combined with retrograde autologous blood priming technology in adult combined cardiac valve surgery.Methods In 60 patients undergoing aortic valve combined with mitral valve replacement,30 patients received del Nido cardiopregia combined with retrograde autologous blood priming technology(observation group),and the other 30 patients received del Nido cardiopregia combined with conventional priming technology(control group).The aortic cross-clamping time,cardiopulmonary bypass time,the frequency and total amount of cardioprotective fluid perfusion,the rate of automatic rebound,the minimum hemoglobin concentration during cardiopulmonary bypass,the hemoglobin concentration immediately after cardiopulmonary bypass,and the utilization rate of ultrafiltration were recorded in two groups.Results The minimum hemoglobin concentrations during and immediately after cardiopulmonary bypass were higher in observation group((95.4±3.1),(108.1±5.4)g/L)than those in control group((74.2±5.9),(92.2±8.5)g/L)(P<0.05),and the utilization rate of ultrafiltration was lower in observation group(53.3%)than that in control group(93.3%)(P<0.05).There were no significant differences in cardiopulmonary bypass time,aortic across-clamping time,postoperative parallel auxiliary time,operation time,heart automatic rebound rate,frequency of cardioprotective fluid perfusion,total amount of cardioprotective fluid perfusion,preoperative hemoglobin concentration,drainage volume on the first day after operation,tracheal intubation and indwelling time,and the length of ICU stay between two groups(P>0.05).Conclusion The application of del Nido cardiopregia combined with retrograde autologous blood priming technology can reduce hemodilution,reduce the utilization rate of ultrafiltration,improve the hemoglobin concentration immediately after cardiopulmonary bypass and benefit the prognosis of adult cardiac surgery.

关 键 词：主动脉瓣膜病 体外循环 血液稀释 自体血逆行预充 del Nido心肌保护液 

分 类 号：R654.2[医药卫生—外科学]