HTK与del Nido保护液对新生儿大动脉转位术中心肌保护作用的倾向性评分匹配研究  

The myocardial protection of HTK versus del Nido cardioplegia solutions in neonates with surgeries for transposition of the great arteries:A propensity score matching study

作　　者：李聪[1] 燕怡辰 陈红彤 祝忠群[1] LI Cong;YAN Yichen;CHEN Hongtong;ZHU Zhongqun(Department of Cardiothoracic Surgery,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai,200127,P.R.China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127

出　　处：《中国胸心血管外科临床杂志》2023年第9期1301-1307,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨HTK与del Nido保护液对新生儿完全性大动脉转位术中心肌保护效果。方法回顾性纳入2014—2020年由上海儿童医学中心收治的大动脉转位新生儿208例,根据所用保护液,将患者分为HTK组和del Nido组。通过倾向性评分匹配法校正混杂因素,比较匹配后两组患儿的术中体外循环时间、主动脉阻断时间、保护液总量、灌注次数、术后住ICU时间、气管插管时间、住院时间、术后正性肌力药物评分、左心室射血分数、N末端B型利钠肽前体及肌钙蛋白等。结果通过倾向性评分匹配,最终共纳入54例患儿,HTK组与del Nido组各27例。HTK组男22例、女5例,年龄7.0(2.0,11.0)d;del Nido组男23例、女4例,年龄8.0(3.0,11.0)d。匹配后全组患儿院内死亡共3例,HTK组2例(7.4%),del Nido组1例(3.7%),两组院内死亡率差异无统计学意义(P=1.000)。HTK组保护液灌注总量显著高于del Nido组(P<0.001)。而del Nido组保护液灌注次数显著多于HTK组(P=0.043)。两组在术后住ICU时间、气管插管时间、住院时间、正性肌力药物评分、左心室射血分数、N末端B型利钠肽前体及肌钙蛋白方面差异无统计学意义(P>0.05)。结论在新生儿完全性大动脉转位手术中,HTK保护液安全有效,可提供与del Nido相似的心肌保护作用。Objective To compare and analyze the effect of myocardial protection between HTK and del Nido cardioplegia solutions in neonates with surgeries for transposition of the great arteries.Methods The clinical data of 208neonates with complete transposition of the great arteries in our institution from 2014 to 2020 were retrospectively analyzed.According to the cardioplegia solutions utilized in the operations,the patients were divided into two groups:a HTK group and a del Nido group.Propensity score matching was conducted to eliminate the biases.The cardiopulmonary bypass time,aortic cross-clamping time,total amount of cardioplegia solutions,transfusion frequency of cardioplegia,ICU stay time,mechanical support time,inotropic score,hospital stay,left ventricular ejection fraction,N-terminal proBNP and troponin I were compared and analyzed between the two groups after matching.Results After 1:1propensity score matching,a total of 54 patients were analyzed with 27 patients in each group.In the HTK group,there were 22 males and 5 females with a median age of 7.0(2.0,11.0)d.In the del Nido group,there were 23 males and 4females with a median age of 8.0(3.0,11.0)d.A total of 3 children died after the surgery:2(7.4%)patients in the HTK group and 1(3.7%)patient in the del Nido group.There was no significant difference in hospital mortality between the two groups(P=1.000).The total amount of cardioplegia solutions in the HTK group was significantly higher than that of del Nido group(P0.001).Transfusion frequency of cardioplegia in del Nido group was significantly higher than that of the HTK group(P=0.043).There was no significant difference in the postoperative ICU time,mechanical support time,length of hospital stay,inotropic score,left ventricular ejection fraction,N-terminal B-type natriuretic peptide precursor or troponin I between the two groups(P0.05).Conclusion For neonates with surgeries for complete transposition of the great arteries,HTK cardioplegia solutions can provide effective and safe myocardial protection,wh

关 键 词：新生儿 完全性大动脉转位 心肌保护 HTK del Nido 

分 类 号：R722.1[医药卫生—儿科]