组氨酸-色氨酸-酮戊二酸停搏液对胸腔镜下微创心脏病手术患者心肌缺血-再灌注损伤的作用研究  

Clinical study on myocardial ischemia-reperfusion injury in patients undergoing thoracoscopic minimally invasive heart disease surgery using HTK solution

作　　者：罗志方 江美兰 江文发 赖政洪 刘子由 LUO Zhi-fang;JIANG Mei-lan;JIANG Wen-fa;LAI Zheng-hong;LIU Zi-you(Department of Thoracic Surgery,The First Affiliated Hospital of Gannan Medical Univers;Gannan Health Vocational College/Ganzhou Health School;Department of Cardiothoracic Surgery,Southern Hospital Ganzhou Hospital,Ganzhou,Jiangxi 341000)

机构地区：[1]赣南医科大学第一附属医院心脏大血管外科 [2]赣南卫生健康职业学院/赣州市卫校 [3]南方医院赣州医院胸心外科,江西赣州341000

出　　处：《赣南医科大学学报》2025年第2期174-176,共3页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：江西省卫生健康委员会科技计划指导性项目(202210904)。

摘　　要：目的:探究体外循环胸腔镜下微创心脏手术中,组氨酸-色氨酸-酮戊二酸(Histidine-tryptophanketoglutarate,HTK)停搏液对患者心肌缺血-再灌注损伤的保护作用。方法:按照手术时间先后顺序,对100例胸腔镜下微创心脏手术患者进行编号,单号患者纳入观察组(术中使用HTK停搏液),双号患者纳入对照组(术中使用改良Thomas停搏液)。比较2组麻醉诱导后、术后心脏复跳后的心肌酶谱(血清)指标,包括肌酸激酶同工酶(Creatine kinase isoenzyme,CK-MB)、肌红蛋白(Myoglobin,Mb)和肌钙蛋白T(Troponin T,cTnT),及术后心脏复跳后的左心室射血分数(Left ventricular ejection fraction,LVEF)。结果:2组麻醉诱导后血清cTnT、Mb、CK-MB含量比较差异无统计学意义(P>0.05)。与麻醉诱导后比较,2组心脏复跳后血清cTnT、Mb、CK-MB含量均明显上升。心脏复跳后观察组血清cTnT、Mb、CK-MB含量低于对照组,差异有统计学意义(P<0.001)。心脏复跳后观察组LVEF明显高于对照组,差异有统计学意义(P<0.001)。结论:在体外循环胸腔镜下微创心脏手术应用HTK停搏液对心肌缺血-再灌注损伤有一定的保护作用。Objective:To explore the protective effect of Histidine-tryptophan-ketoglutarate(HTK)solution on myocardial ischemia-reperfusion injury in patients undergoing minimally invasive endoscopic cardiac surgery with cardiopulmonary bypass.Methods:A total of 100 patients undergoing minimally invasive cardiac surgery via thoracoscopy were numbered according to the order of their operation time.Patients with odd-numbered serial numbers were included in the observation group(HTK solution was used during the operation),and patients with even-numbered serial numbers were included in the control group(modified Thomas solution was used during the operation).The left ventricular ejection fraction(LVEF)of the two groups after the heart resumed beating after the operation was compared.The myocardial enzyme spectrum(serum)indexes,including creatine kinase isoenzyme(CK-MB),myoglobin(Mb),and troponin T(cTnT),were compared between the two groups after anesthesia induction and after the heart resumed beating after the operation.Results:There was no significant difference in serum cTnT,Mb and CK-MB contents between 2 groups after anesthesia induction(P>0.05).The contents of cTnT,Mb and CK-MB in serum of 2 groups were significantly increased after cardioversion compared with induction of anesthesia.cTnT,Mb and CK-MB in the observation group were lower than those in the control group after cardioversion,and the difference was statistically significant(P<0.001).The LVEF in the observation group was significantly higher than that in the control group after cardioversion,and the difference was statistically significant(P<0.001).Conclusion:The application of HTK solution in minimally invasive endoscopic cardiac surgery with cardiopulmonary bypass has a certain protective effect on myocardial ischemia-reperfusion injury.

关 键 词：心脏外科手术 胸外科手术 电视辅助 组氨酸-色氨酸-酮戊二酸停搏液 心肌缺血-再灌注损伤 

分 类 号：R619.5[医药卫生—外科学]