康斯特保护液与其它心脏停搏液心肌保护作用比较

Compare the Myocardial Protection Effect of HTK with Other Cardioplegic Solutions

目的观察康斯特保护液(HTK液)、冷含血停搏液与冷晶体停搏液在成人心脏手术中的心肌保护效果。方法60例成人心脏手术患者随机分为三组,每组20例。分别为HTK液组、冷含血停搏液组(BC)、冷晶体停搏液组(CC)。测定围术期血浆cTnI、CKMB水平。术中取心肌组织观察心肌缺血前后超微结构改变。临床观察心脏自动复跳率、体外循环停止时多巴胺用量、术后拔管时间、ICU滞留时间。结果三组cTnI、CKMB分别于术后1 d、ICU 1 h达到高峰。主动脉开放后10 m in,HTK液组cTnI低于BC组与CC组(P<0.05);ICU 1 h时点CC组cTnI高于HTK液组(P<0.05)。超微结构观察,CC组心肌损伤程度较HTK液组、BC组重。HTK液组与BC组自动复跳率明显高于CC组(P<0.05)。体外循环停止时多巴胺用量5μg^10μg/(kg.m in)者,HTK液组少于BC组及CC组(P<0.05)。结论HTK液可减轻心肌缺血再灌注损伤,与冷含血停搏液、冷晶体停搏液相比具有较好的心肌保护作用。

OBJECTIVE The purpose of this study is to compare the myocardial protective effect of HTK solution, cold blood cardioplegic solution（BC） and cold crystalloid cardioplegia（CC） in adult open heart surgery. METHODS Sixty patients were randomized to receive HTK solution （ group Ⅰ , n = 20）, BC （ group Ⅱ, n = 20）, or CC （ group Ⅲ, n = 20）. Plasma levels of cardiac troponin I （cTnI） and creatine kinase MB（CK -MB） were measured perioperatively. Biopsies of fight atrium were taken to be analyzed under electron microscope. Spontaneous resuscitation rate, the requirement for inotropics at the end of CPB, intubation time and length - of - stay in ICU were also evaluated. RESULTS The concentration of cTnI and CKMB were elevated after the onset of CPB, with the maximal value of cTnI on the first postoperative day , and the peak of CKMB at 1 h after entering ICU in all groups. HTK group had lower cTnI values compared to group Ⅱ and group Ⅲ （ p 〈0.05） at 10 min after aortic declamping,and also had lower cTnI compared to CC group at the point of ICU 1h （ P 〈 0.05）. Ultrastructure changes were slighter in HTK group and BC group than in group Ⅲ. The rate of spontaneous defibrillation was higher in group Ⅰ , Ⅱ （ P 〈 0.05） than in group Ⅲ. Cases used dopamine 5μg - 10μg（ kg·min）at the end of CPB was fewer in HTK group than the other two groups （ P 〈 0.05 ）. CONCLUSION Compared with other two groups, HTK solution could decrease the ischemia - reperfusion injury , had benefit for the recovery of heart function.