两种进口停搏液在心脏瓣膜置换术中的临床效果比较  

Comparison of the clinical effects of del Nido cardioplegia and HTK cardioplegia in cardiac valve replacement

作　　者：黄虹皓 杨柯 魏晓红[1] 何思毅 周一 高峰 张近宝 李霞 辛梅 Huang Honghao;Yang Ke;Wei Xiaohong;He Siyi;Zhou Yi;Gao Feng;Zhang Jinbao;Li Xia;Xin Mei(Department of Cardiovascular Surgery,General Hospital of Western Theater Command,Sichuan Chengdu 610083,China)

机构地区：[1]中国人民解放军西部战区总医院心胸外科,成都610083 [2]西南交通大学医学院,成都610031

出　　处：《中国体外循环杂志》2024年第2期98-104,125,共8页Chinese Journal of Extracorporeal Circulation

基　　金：国家青年科学基金项目(82102506);四川省干部保健科研项目任务书(川干研2023-1301)。

摘　　要：目的本文旨在对del Nido心肌停搏液(DN)与组氨酸-色氨酸-酮戊二酸停搏液(HTK)在心脏瓣膜置换术中的临床效果进行回顾性分析,以期为其临床应用提供参考。方法回顾性分析2018年1月1日至2023年9月10日期间496例在本院心血管外科就诊的患者资料。按照排除标准剔除部分资料,并使用SPSS 22.0统计软件包对两组患者的部分特征进行倾向性评分匹配,最终纳入102例患者,其中DN组51例,HTK组51例。记录两组患者术中特征,并对比术后两组患者不同时间血清肌酸激酶同工酶(CKMB)、心肌肌钙蛋白I(cTnI)、血气分析和并发症情况。取入ICU时间点的心肌损伤标志物与主动脉阻闭时间进行相关性分析。最后将主动脉阻闭时间分为<90 min与90~120 min两组进行亚组分析。结果两组患者基本特征在倾向性匹配前与匹配后均无统计学意义。术中DN组与HTK组的停搏液+总量、K浓度、心肺转流时间与主动脉夹闭时间在倾向性匹配前后差异均具有统计学意义(P<0.05)。DN组(R=0.878,R=0.758,P<0.001)与HTK组(R=0.951,R=0.925,P<0.001)的主动脉夹闭时间与CKMB、cTnI具有一定的相关性。亚组分析显示在90~120 min内DN组与HTK组的CKMB、cTnI值差异具有统计学意义(P<0.05)。结论两种停搏液均具有较高的安全性。在主动脉阻断时间<90 min时的两组心肌保护效果无明显差异,90~120 min时DN可能具有更好的心肌保护效果。Objective To retrospectively evaluate the clinical effects of del Nido and histidine-tryptophane-ketoglutarate(HTK)cardioplegia during cardiac valve replacement,with the aim of providing reference for their clinical application.Methods Data from 496 patients who underwent treatment at Department of Cardiovascular Surgery,General Hospital of Western Theater Command between January 1st,2018 and September 10th,2023 were retrospectively analysed.Exclusion criteria eliminated certain data,and bias score matching was done on some attributes of both groups with the SPSS22.0 statistical software.A total of 102 patients were enrolled,with 51 in the DN group and 51 in the HTK group.The intraoperative characteristics of both groups were documented,and the myocardial injury markers CK-MB and cTnI,along with the results of blood gas analysis and complications,were compared between them at various time intervals following surgery.The study examined the correlation between myocardial injury markers and the duration of aortic occlusion time in the ICU.Lastly,the aortic occlusion time was classified into two subgroups:less than 90 minutes and 90-120 minutes,for further analysis.Results The fundamental characteristics of patients in both groups showed no statistical significance before and after propensity matching.However,there were statistically significant differences in the total amount of cardioplegia,K+,CPB time,and aortic clamping time observed among the DN and HTK groups before and after propensity matching(P<0.05).Notably,the aortic clamping time in the DN and HTK groups exhibited a positive correlation with CK-MB and cTnI.There were statistically significant variations in CK-MB and cTnI levels between the DN and HTK groups during 90-120 minutes,as indicated by subgroup analysis(P<0.05).Conclusion Both types of cardiac arrest fluids are highly safe.Moreover,no significant difference was found in the myocardial protection effect between the two groups while using the two cardioplegia solutions for surgeries lasting less th

关 键 词：心脏停搏液 心脏瓣膜病 瓣膜置换术 心肺转流 心肌保护 

分 类 号：R654.2[医药卫生—外科学]