HTK液与含血停搏液对瓣膜置换术中心肌保护的研究

Compare the myocardial protection effect of HTK solution with blood cardioplegic solution during valve replacement surgery

目的比较HTK液和含血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42例风湿性心脏病联合瓣膜病的患者分为对照组（应用4：1冷含血停搏液）和实验组（应用HTK液）。测定麻醉诱导前、术后6、12、24h的心排量（CO）和心脏指数（CI），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。结果实验组患者术后12h和24h监测点心排量和心指数均高于对照组[12h：（4．82±0．18）IMminvs（3．50±0．32）L／min，（3．80±0．48）I／（min·m^2）vs（2．79±0．39）I／（min·m^2）；24h：（4．97±0．45）L／minV8（3．81±0．19）L／min，（4．22±0．17）L／（min·m^2）vs（2．91±0．21）L／（min·m^2），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，多巴胺最大剂量、呼吸机支持时间均低于对照组[（53．6±24．3）min vs（68．9±26．1）min；（1．8±1．3）min vs（2．3±1．2）min；（33±11）min vs（42±13）min；（10．2±2．1）μg／（kg·min）vs（15．7±3．8）μg／（kg·min）；（14．6±4．8）hV8（20．7±5．1）h，P〈0．05]，心脏自动复跳率高于对照组（90％ vs 67％，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实验组中明显减少。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 evaluate the effect of HTK solution on myocardial protection during valve replacement surgery. Methods 42 patients with rheumatic heart disease were randomized to receive 4：1 cold blood （ control group, n = 21 ） and HTK （ protective group, n = 21 ） cardioplegic solution during valve replacement. The changes of CO and CI were collected at different time points including pre-operation, postoperative 6 hours, 12 hours and 24 hours. Aortic clamping time, the ratio of spontaneous cardiac rhythm recovery and inotropic drugs application were calculated, and mechanical ventilation support time and the incidence of arrhythmia were recorded. Results The measurements of CO and CI showed that there was significant higher level in protective group at postoperative 12 hours and 24 hours [ 12 h： （4. 82 ± 0. 18）L/ min vs （ 3.50 ± 0. 32 ） L/min, （ 3.80 ± 0. 48 ） L/（ min ± m^2 ） vs （ 2.79 ± 0. 39 ） L/（ min ±m^2 ） ;24 h ： （4.97±0.45）L/min vs （ 3.81 ±0. 19）L/min, （4.22±0. 17）L/（min ± m^2） vs （2.91 ±0. 21） L/ （ min. m^2 ） , P 〈 0. 05 ]. The clinical parameters including aortic clamping time, incidence of cardiac arrhythmia, inotropic support, duration of mechanical ventilation and length was lower than in control group [ （53.6± 24.3）minvs （68.9±26.1）min;（1.8±1.3）minvs （2.3±1. 2）min;（33±11）min vs （42±13）min; （10. 2±2. 1）μg/（kg . min） vs （15.7 ±3.8） μg/（kg.min） ;（14. 6 ±4. 8）h vs （20.7 ±5.1）h, P 〈 0. 05 ]. The auto-beating rate was higher than in control group （90% vs 67% , P 〈0. 05）. Conclusions HTK solution is better than classical blood cardioplegia in myocardial protection during valve replacement.