不同心肌保护液在全胸腔镜微创主动脉瓣置换手术中的应用效果比较  

Comparison of application effects among different myocardial protective solutions in total thoracoscopic minimally invasive aortic valve replacement surgery

作　　者：李天宝 张永苹 章晓华[1] 孟擎擎 何海林 贺子剑 全梓林 周成斌[1] LI Tianbao;ZHANG Yongping;ZHANG Xiaohua;MENG Qingqing;HE Hailin;HE Zijian;QUAN Zilin;ZHOU Chengbin(Department of Cardiovascular Surgery,Affiliated Guangdong Provincial People’s Hospital,Southern Medical University(Guangdong Provincial Academy of Medical Science),Guangzhou,Guangdong 510080,China)

机构地区：[1]南方医科大学附属广东省人民医院(广东省医学科学院)心外科,广州510080

出　　处：《重庆医学》2024年第21期3201-3205,共5页Chongqing Medical Journal

基　　金：国家重点研发计划课题(2023YFC2410305)。

摘　　要：目的探讨不同心肌保护液在全胸腔镜微创主动脉瓣置换手术中的应用效果。方法回顾性分析2020年5月至2024年1月在该院行全胸腔镜微创主动脉瓣置换手术的72例患者病例资料。根据使用不同心肌保护液分为St.Thomas停搏液组(STH组,n=13)、del Nido停搏液组(DN组,n=24)、组氨酸-色氨酸-酮戊二酸酯液组(HTK组,n=35)。比较各组术前、术中乳酸(Lac)水平,术前、手术当天及术后最高心肌型肌酸激酶同工酶(CK-MB)、肌钙蛋白T(TnT)及肌酐(Cr)水平,体外循环时间、主动脉阻断时间、体外循环最大流量、体外循环最低膀胱温度、停搏液灌注次数、主动脉开放后除颤比例、术后呼吸机辅助时间、住ICU时间、术后住院时间。结果除1例HTK组患者术后自动出院外,其余71例患者均康复遵医嘱出院。3组年龄、体重、体外循环时间、主动脉阻断时间、体外循环最大流量、体外循环最低膀胱温度、体外循环前Lac、体外循环最高Lac、术后呼吸机辅助时间、住ICU时间、术后住院时间、术前Cr、术后当天Cr、术后最高Cr、术前TnT、术后当天TnT、术后最高TnT、术前CK-MB、术后当天CK-MB、术后最高CK-MB比较差异均无统计学意义(P>0.05),主动脉开放后除颤比例和心肌保护液灌注次数比较差异有统计学意义(P<0.05)。心肌保护液灌注次数组间两两比较差异均有统计学意义(P<0.05),DN组主动脉开放后除颤比例与HTK组比较差异有统计学意义(P<0.05)。结论DN、STH和HTK在全胸腔镜微创主动脉瓣置换手术中均具有良好的心肌保护效果。HTK相对DN、STH具有较少灌注次数,减少手术操作的优势;DN相对HTK在主动脉开放后有较低使用电除颤纠正心律失常比例的优势。Objective To investigate the application effects of different myocardial protective solutions in total thoracoscopic minimally invasive aortic valve replacement surgery.Methods The clinical data of 72 patients with total thoracoscopic minimally invasive aortic valve replacement surgery in this hospital from May 2020 to January 2024 were analyzed retrospectively.The patients were divided into the St Thomas cardioplegia group(STH group,n=13),del Nido cardioplegia group(DN group,n=24),histidine tryptophan ketoglutarate solution group(HTK group,n=35)according to the different myocardial protective solutions.The levels of lactate(Lac)before and during surgery,the highest levels of myocardial creatine kinase isoenzyme(CK-MB),high-sensitivity troponin T(TnT)and creatinine(Cr)before operation,on the operative day and after surgery as well as the duration of extracorporeal circulation,aortic cross-clamping time,maximum flow rate,minimum bladder temperature,cardioplegia perfusion times,number of defibrillation after aortic de-clamping,postoperative ventilator assisted time,ICU stay duration and postoperative hospitalization duration were compared among the three groups.Results Except for 1 case of HTK was discharged automatically after surgery,the other 71 cases recovered and discharged according to the doctor’s advice.There were no statistically significant differences in the age,body weight,extracorporeal circulation time,aortic blocking time,maximum flow volume of extracorporeal circulation,minimum bladder temperature of extracorporeal circulation,Lac before extracorporeal circulation,highest Lac during extracorporeal circulation,assistant time of postoperative ventilator,ICU stay duration,postoperative hospitalization duration,serum Cr before operation,Cr on operative day,preoperative TnT,postoperative TnT on operative day,postoperative highest TnT,preoperative CK-MB,postoperative CK-MB on operative day and postoperative highest CK-MB among the three groups(P>0.05).There were statistically significant differences in

关 键 词：全胸腔镜 微创主动脉瓣 心肌保护 

分 类 号：R654.2[医药卫生—外科学]