机器人体外循环下心脏手术的心肌灌注方法及效果

Myocardial perfusion methods and effects in da Vinci S robot assisted cardiac operation with extracorporeal circulation

目的探讨机器人体外循环下心脏手术时不同心肌灌注方法的临床效果。方法回顾2007年1月～2011年8月间采用da Vinci S机器人系统体外循环下行心脏手术242例患者,按其心肌保护时采用不同的灌注液分为三组:含血停搏液组(n=150);HTK液组(n=30)和不停跳组(n=62)。分别采集术前患者一般状况、手术方式、术前和术后左室射血分数(EF)、体外循环时间、主动脉阻断时间、心脏复苏状况、肌酸激酶(CK)和肌酸激酶同工酶(CKMB)术前、手术当日、术后第1天和术后第3天等数据进行分析比较。结果术前三组患者一般状况、术前和术后EF值各组间比较无统计学差异(P>0.05)。含血停搏液组和HTK液组的手术方式、体外循环时间、阻断时间和自动复苏率两组间比较亦无差异(P>0.05),停搏液用量HTK液组明显多于含血停搏液组(P<0.01)。含血停搏液组和HTK液组与不停跳组比较手术方式和体外循环时间有显著差异(P<0.05),不停跳组手术为房间隔缺损修补或右房黏液瘤摘除。CK和CKMB在术前、手术后当日、术后1日和3日各组组间比较均无差异(P>0.05),各组手术当日和术后1日与术前比较均明显地高于术前,有极显著差异(P<0.01),术后3日则已恢复至术前水平(P>0.05)。所有患者均恢复顺利,痊愈出院。结论在机器人心脏手术中,采用含血停搏液或HTK液灌注心肌的保护方法均能获得与不停跳心肌保护方法相同的效果。

Objective To observe mocardial perfusion methods and effects in Robot assisted surgery with extracorporeal circulation （ECC）. Methods From Jan. 2007 to Aug. 2011, 242 patients underwent cardiac surgery with Robot da Vivci 4S system and ECC were reviewed. Patients were divided into three groups according to the different cardioplegia and myocardial perfusion methods： blood cardioplegia group （n = 150）, HTK cardioplegia group （n = 30） and beating heart without cardioplegia group （n = 62）. The left ventricle ejection fraction （EF） before and after operation, ECC time, aortic clamping time, cardiac resuscitation rate, cardioplegia volume, blood concentration of creatine kinase （CK） and creatine kinase MB （CKMB） before and after operation of patients were collected. Results The patients＇general station and EF preoperatively and postoperatively in three groups were comparative （ P 〉 0.05 ）. The operation time, ECC time, aortic clamping time, cardiac resuscitation rate had no significant difference （ P 〉 0.05 ） between blood cardioplegia group and HTK cardioplegia group. The cardioplegia volume of HTK cardioplegia group was more than blood cardioplegia group （ P 〈 0.01 ）. The operation procedures in the blood cardioplegia group and HTK cardioplegia group, which need longer ECC time （ P 〈 0.05）, were different compared with that in the beating heart without cardioplegia group （ P 〈 0.05）. The concentration of CK and CKMB on the preoperative day, operative day, 1 day and 3 day postoperatively in the three groups had no significant difference （ P 〉0.05）, which was increased significantly on the the opreative day and 1 day postoperatively （ P 〈0.01 ） and recovered on 3 day postoperatively compared with that before operation. All patients were operated successfully and recovered smoothly without complications. Conclusion The blood cardioplegia or HTK cardioplegia can provide comparative myocardial protective effects as beating heart in Robot assissted surgery with ECC.