心脏停搏液在A型主动脉夹层手术中应用的临床效果研究  

Application of del Nido cardioplegia in type A aortic dissection surgery

作　　者：高兰英 薄致远 陈剑[1] 陈杰 王伟[1] 何琳 贾彬[1] Gao Lanying;Bo Zhiyuan;Chen Jian;Chen Jie;Wang Wei;He Lin;Jia Bin(The Third People’s Hospital of Chengdu,Sichuan Chengdu 610000,China)

机构地区：[1]成都市第三人民医院,成都610000

出　　处：《中国体外循环杂志》2025年第2期101-107,共7页Chinese Journal of Extracorporeal Circulation

基　　金：四川省自然科学基金(面上项目)(2024NSFSC0646)。

摘　　要：目的比较delNido停搏液与含血停搏液用于急性A型主动脉夹层急诊手术的心肌保护效果。方法回顾性分析成都市第三人民医院2020年1月至2024年8月因急性A型主动脉夹层接受急诊外科手术的151例成人患者。根据术中采用的心脏停搏液分为传统含血停搏液组(传统组,n=95)和del Nido停搏液组(DN组,n=55)。采用倾向性评分1:1匹配,得到术前术中基础数据均衡的2组样本作比较分析。主要研究终点是术后48 h肌酸激酶同工酶(CKMB)、高敏肌钙蛋白(HS-TnT)。次要研究终点包括术后48h乳酸脱氢酶(LDH)、肌酸激酶(CK)、α-羟丁酸脱氢酶(α-HBDH)、术后48 h左室射血分数(LVEF)、机械通气时间、ICU停留时间。对术前存在血清CKMB>4.87μg/L的患者做亚组分析。结果倾向性匹配得到2组各32例样本,分析术后两组48 h CKMB、HS-TnT均无显著统计学差异(P>0.05);次要研究终点无差异。亚组分析术前心肌损伤患者(传统组n=66例,DN组n=19例)术后48hCKMB(P=0.086)、HS-TnT(P=0.103),两组无显著统计学差异;CK(P=0.042)、LDH(P=0.001)传统组显著高于DN组。结论del Nido停搏液和传统含血停搏液用于A型主动脉夹层患者的心肌保护效果相似,对于术前存在心肌损伤的患者delNido停搏液可能更有益。Objective To compare the efficacy of del Nido cardioplegia(DNC)and conventional blood cardioplegia(BCP)in myocardial protection during emergency surgery for acute type A aortic dissection.Methods A retrospective analysis was performed on 151 adults undergoing emergency ATAAD repair at Chengdu Third People’s Hospital from January 2020 to August 2024.According to intraoperative cardioplegia,the patients were divided into BCP(n=95)and DNC(n=55)groups.Propensity scorematching(1:1)generated 32 matched pairs with balanced baseline characteristics.Primary endpoints were postoperative 48-hour creatine kinase-MB(CK-MB)and hy-sensitivity troponin T(HS-TnT).Secondary endpoints included postoperative 48-hour lactate dehydrogenase(LDH),creatine kinase(CK),α-hydroxybutyrate dehydrogenase(α-HBDH),left ventricular ejection fraction(LVEF%),mechanical ventilation duration,and ICU stay.A subgroup analysis focused on preoperative myocardial injury(serum CK-MB>4.87μg/L).Results After matching,no significant differences were observed in 48-hour CK-MB or hs-TnT between BCP and DNC groups(P>0.05).Secondary outcomes,including LVEF,mechanical ventilation time,and ICU stay were comparable.In the preoperative myocardial injury subgroup(BCP:n=66;DNC:n=19),CK-MB(P=0.086)and hs-TnT(P=0.103)remained nonsignificant.However,DNC demonstrated significantly lower postoperative CK(P=0.042)and LDH(P=0.001)compared to BCP.Conclusion DNC and BCP provide equivalent myocardial protection in ATAAD surgery.However,DNC may reduce postoperative myocardial enzyme release in patients with preoperative injury,suggesting its preferential use in high-risk cohorts.

关 键 词：体外循环 delNido停搏液 含血停搏液 急性A型主动脉夹层 心肌保护 

分 类 号：R654.2[医药卫生—外科学]