瓣膜置换术中HTK液和高钾停搏液对心肌保护作用的比较研究

Comparative Study of the Effect of HTK vs Hyper-potassium Cardioplegic Solution on Myocardial Protection During Valve Replacement Surgery

【目的】比较康斯特保护液（HTK液）和含血高钾停搏液在风湿性心脏病患者瓣膜置换术中的心肌保护效果。【方法】51例风湿性心脏病联合瓣膜病的患者随机分为对照组（应用4：1冷含血停搏液，n=21）和试验组（应用HTK液，n=30）。分别于术前、术后24h、72h、7d时检测外周静脉血中B型脑钠肽（BNP）和心肌肌钙蛋白I（cTnI）水平，并比较两组患者主动脉阻断时间、主动脉开放到心脏复跳时间、辅助循环时间、心脏自动复跳率、心律失常、起搏器应用、多巴胺平均最大剂量、呼吸机支持时间等临床指标。【结果】试验组术后BNP与cTnI升高水平均低于对照组（P〈0．05）；主动脉阻断时间、主动脉开放到心脏复跳时间、辅助循环时间，多巴胺平均最大剂量、呼吸机支持时间均低于对照组（P〈0．05），心脏自动复跳率高于对照组（P〈0．05），术后出现心律失常、低心排和使用临时心脏起搏器的患者数在试验组中明显减少。【结论】HTK心脏停搏液对风湿性心脏病患者瓣膜置换术中心肌的保护作用优于1：4含血停搏液。

[Objective] To compare the effect of HTK vs blood/hyperkalemic cardioplegic solution on myocardial protection of patients with rheumatic heart disease during valve replacement surgery. [Methods] Forty two cases of rheumatic heart disease with valvular disease were randomly divided into control group（4：1 cold blood cardioplegic solution） and experimental group（ HTK solution）. The level of B-type natriuretic peptide（BNP） and cTnI in peripheral venous blood were detected 24h, 72h and 7d after operation. Aortic clamping time, the time of aorta open to spontaneous cardiac rhythm recovery, the time of assisted circulation, the ratio of spontaneous cardiac rhythm recovery, arrhythmia, pacemaker usage, average maximum dosage of dopamine and mechanical ventilation support time were compared between two groups. [Results] The level of BNP and cTnI in experimental group after operation were lower than those in control group（ P 〈0.05）. Aortic clamping time, the time of aorta open to spontaneous cardiac rhythm recovery, the time of assisted circulation, average maximum dosage of dopamine and mechanical ventilation support time in experimental group were lower than those in control group （ P 〈 0.05 ）. The ratio of spontaneous cardiac rhythm recovery in experimental group was higher than that in control group（ P〈0.05）. The incidence of arrhythmia and low cardiac output and the number of patients using temporary pacemakers in experimental group decreased obviously. [Conclusion] HTK cardioplegic solution for myocardial protection during valve replacement surgery is superior to 1：4 blood cardioplegia.