低剂量心肌保护液心脏灌注在孤立瓣膜手术中的应用  

Application of low-dose cardioplegia cardiac perfusion in single valve surgery

作　　者：国一白 梁冰 张怡雯 刘宇 Guo Yibai;Liang Bing;Zhang Yiwen;Liu Yu(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Liaoning Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管外科,沈阳110016

出　　处：《中国体外循环杂志》2025年第1期40-43,57,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的 评估对比低剂量组氨酸-色氨酸-酮戊二酸(HTK)心脏停搏液在孤立瓣膜手术中的心肌保护效果代替常规剂量是否可行。方法 回顾性分析北部战区总医院心血管外科2023年8月至2023年12月共184例孤立瓣膜手术的临床资料。根据术中HTK心脏停搏液的剂量分为低剂量组(n=81)及常规剂量组(n=83)。收集并分析两组患者的肌钙蛋白T(c Tn T)、肌酸激酶同工酶(CKMB)、术式、体外循环时间、主动脉阻断时间、左心室射血分数(LVEF)、术后ICU时间,住院时间,死亡率等临床数据。结果 两组患者术前一般资料无显著差异(P> 0.05)。低剂量组与常规剂量组相比,灌注时间上具有统计学差异,低剂量组的灌注时间显著小于常规剂量组;体外循环时间、主动脉阻断时间、术后c Tn T、呼吸机辅助时间、ICU停留时间均无显著差异。结论 低剂量HTK心脏停搏液在孤立瓣膜手术中应用安全、可行,可以达到与常规剂量灌注相似的临床效果。Objective To evaluate the feasibility of replacing conventional doses of histidine tryptophan ketoglutarate(HTK)perfusion solution with a low-dose HTK solution for myocardial protection in single valve surgery.Methods A retrospective analysis was conducted on the clinical data of 184 cases of single valve surgery in the Cardiovascular Department of the General Hospital of the Northern Theater Command from August 2023 to December 2023.Patients were divided into the low-dose group(n=81)and the conventional-dose group(n=83)based on the intraoperative dosage of HTK perfusion solution Clinical data,including cardiac troponin(cTNT),creatine kinase-MB(CKMB),surgical procedures,extracorporeal circulation time(ECC),aortic cross-clamp(ACC)time,left ventricular ejection fraction(LVEF),postoperative ICU time,length of hospital stay,and mortality rate,were collected and analyzed.Results There were no significant difference in baseline characteristics between the two groups(P>0.05).The low-dose group demonstrated a significantly shorter perfusion time compared to the conventional-dose group(P<0.05).No significant differences were observed in ECC time,ACC time,postoperative cTNT,levels,mechanical ventilation duration,and ICU stay time between the low groups.Conclusion Low-dose HTK perfusion is safe and feasible in single valve surgery,achieving comparable clinical outcomes to conventional-dose perfusion.

关 键 词：组氨酸-色氨酸-酮戊二酸心脏停搏液 瓣膜手术 心肌保护 肌钙蛋白 低剂量灌注 

分 类 号：R54[医药卫生—心血管疾病]