胸腔镜辅助右腋下小切口心脏手术中使用改良del Nido液临床经验总结  

Clinical experience summary of modified del Nido cardioplegia for video-assisted right subaxillary minimally invasive cardiac surgery

作　　者：胡志斌 毛文帅 郭李君 刘志伟 葛根贤 王树伟 刘志芳 周冰 崔勇 Hu Zhibin;Mao Wenshuai;Guo Lijun;Liu Zhiwei;Ge Genxian;Wang Shuwei;Liu Zhifang;Zhou Bing;Cui Yong(Department of Cardiovascular Surgery,Heart Center,Zhejiang Provincial People’s Hospital(Affiliated People’s Hospital,Hangzhou Medical College),Hangzhou,Zhejiang,China)

机构地区：[1]杭州医学院附属人民医院(浙江省人民医院)心脏大血管外科,杭州310014

出　　处：《中国体外循环杂志》2024年第2期93-97,共5页Chinese Journal of Extracorporeal Circulation

基　　金：浙江省医药卫生科技计划项目(2023KY492)。

摘　　要：目的总结胸腔镜辅助右腋下小切口心脏手术中使用改良del Nido液行心肌保护的临床效果。方法回顾性分析本院自2018年开展胸腔镜辅助右腋下小切口心脏手术以来,采用4份血比1份del Nido液混合组成改良del Nido液,以每隔60 min复灌一次的方法实施心肌保护措施的患者临床资料。包括患者术前一般特征、术中资料、术后心肌损伤标志物与术后转归等。结果5年期间体外循环中采用改良del Nido液使心脏停跳下微创手术908例。围术期主要指标:①心脏自动复跳率为93.28%。②所有患者术后24 h内心肌肌钙蛋白I(cTnI)较术前均有明显增高(P<0.05)。主动脉阻断时间在90 min内,单次灌注时间≤60 min与61~90 min组相比较cTnI无显著性差异(P=0.116);主动脉阻断时间超过90 min,cTnI随着灌注间隔时间延长而增高,灌注间隔时间61~90 min组与>90 min组比较无显著性差异,但均较≤60 min组显著增高(P=0.026,P=0.010)。③微创心脏手术总体预后较佳,术后30 d内死亡率仅1.87%。结论在胸腔镜辅助右腋下小切口心脏手术中使用改良del Nido液单次灌注可使心脏长时间停搏;每隔60 min间断灌注心肌及单次灌注不超过90 min是安全有效的。Objective To summarize the myocardial protective effect of modified del Nido cardioplegia(MDNC)for video-assisted right subaxillary minimally invasive cardiac surgery.Methods A MDNC consisting of 4 parts blood and 1 part del Nido Cardioplegia was used for video-assisted right subaxillary minimally invasive cardiac surgery since 2018 to 2022.Our myocardial protection strategy consisted of single-dose MDNC perfused if aortic cross-clamp(ACC)time within 90 minutes and reperfused per 60 minutes if ACC time over 90 minutes.Retrospective analysis of the patients’clinical data including preoperative basic characteristics,intraoperative data,postoperative cTnI,postoperative outcome and so on were conducted.Results During 5 years,Minimally invasive cardiac surgery using MDNC was performed in 908 cases.Major perioperative indicators including:1)Spontaneous rhythms recovery rate was 93.28%.2)All patients had a significant increase in cTnI in the 24h postoperative period(P<0.05).Patients were divided into three groups according to perfused interval time,groupⅠ:≤60 minutes,groupⅡ:between 61-90 minutes,groupⅢ:>90 minutes.The difference in cTnI between groupsⅠandⅡwas not statistically significant when ACC time was within 90 minutes(Z=-1.572,P=0.116).In patients with over 90 minutes of ACC time,cTnI increased with longer perfusion intervals.The difference between the groupⅡand groupⅢwas not statistically significant,but the cTnI in the two groups were significantly higher than the groupⅠ(Z=-2.232,P=0.026,Z=-2.569,P=0.010).3)Minimally invasive cardiac surgery had a good outcome,with a mortality rate of only 1.87%at 30d postoperatively.Conclusion In our initial experience,single-dose perfusion of MDNC for video-assisted right subaxillary minimally invasive cardiac surgery can prolong the time of cardiac arrest.Intermittent myocardial reperfusion at 60-min intervals and single dose perfusion for up to 90 min are safe and effective.

关 键 词：del Nido液 心肌保护 胸腔镜辅助 微创 心脏手术 

分 类 号：R654.2[医药卫生—外科学]