温血停搏液和HTK液对二尖瓣手术右心保护作用研究

Protective effects of warm blood cardioplegia and histidine-tryptophume-hetoglutarate solution for right ventricular in mitral valve surgery

目的比较温血停搏液和HTK液对二尖瓣手术患者右心功能的保护效果。方法体外循环下进行二尖瓣手术患者85例，随机分为HTK液组（43例）和温血停搏液组（WBC组，42例），每组再根据术前三尖瓣环收缩期位移（TAPSE）是否≥15mm分为两组，比较两组患者升主动脉阻断时间、体外循环时间、辅助通气时间、心肌缺血再灌注后心律失常发生情况、术后在重症监护室（ICU）停留时间和住院时间等临床指标，并测定术前、术后血肌钙蛋白I（cTnT）、磷酸肌酸酶同工酶（CK—MB）、右心室射血分数（RVEF）、右心室舒张末期容积（RVEDV）、心脏指数（cI）和肺毛细血管楔压（PCWP）。结果两组患者均顺利完成手术，HTK组有1例患者术后死于心肌梗死，两组患者主动脉阻断时间、体外循环时间、辅助通气时间比较差异无统计学意义（P〉0．05），WBC组与HTK组各有8例和17例升主动脉开放后发生心律失常（P〈0．05）；对于TAPSE≥15mm的患者，WBC组术后住院时间低于HTK组（P〈0．05），ICU停留时间、CK—MB和cTnT组问无明显差异（P〉0．05），WBC组RVEF、RVEDV、CI和PCWP均优于HTK组，但只有部分时点比较差异有统计学意义（P〈0．05）；对于TAPSE〈15mm的患者，WBC组ICU停留时间、术后住院时间、CK—MB和cTnT均低于HTK组（P〈0．05），CI稍高于HTK组，术后48小时组间比较差异有统计学意义（P〈0．05），RVEF、RVEDV和PCWP等指标术中、术后各时点WBC均优于HTK组（P〈0．05）。结论WBC在二尖瓣手术中右心保护作用优于HTK液，特别对于术前右心功能不全患者。

Objective To evaluate warm blood cardioplegia（ WBC ）and histidine-tryptophume- hetoglutarate （HTK） solution for right ventricular function in mitral valve surgery. Methods A total of 85 patients who underwent mitral valve surgery supported by cardiopulmonary bypass（CPB） were divided into the WBC group（ n =42）and HTK group（ n =43 ） ,randomly. An index of right ventricular systolic function was used to divide patients into groups having impaired （TAPSE 〈 15 mm）or preserved （TAPSE ≥ 15 mm） right ventricular function. Aortic clamp time, CPB time, assisted ventilation time, arrhythmias after myocar- dial ischemia reperfusion, ICU stay and postoperative stay were compared between two groups. Indicators of cTnT, CK-MB, right ventricular ejection fraction （ RVEF ）, right ventricular end-diastolic volume （ RV- EDV）, cardiac index（CI） and pulmonary capillary wedge pressure （PCWP）were measured preoperatively and postoperatively. Results All patients were operated successfully but one patient died for myocardial infarction in the HTK group. There were no differences in aortic clamping time, CPB time and assisted ventilation time between two groups （ P 〉 0.05 ）. Eight and seventeen patients appeared arrhythmia after ascending aorta opening in the WBC group and HTK group, respectively （ P 〈 0.05 ）. In patients with a TAPSE larger than or equal to 15 mm,postoperative stay of the WBC group was less than the HTK group （ P 〈 0.05 ）. ICU stay time, CK-MB and cTnT had no significant difference between groups （ P 〉 0. 05 ）. RVEF, RVEDV, CI and PCWP of the WBC group were superior than the HTK group, but the significant difference was only observed at some time-point（ P 〈 0.05 ）. In patients with a TAPSE less than 15 ram, ICU stay time,postoperative hospital stay, CK-MB and cTnT of the WBC group were lower than the HTK group（ P 〈 0.05 ）. CI of the WBC group was slightly higher than the HTK group in 48h after operation （ P 〈 0.05 ）. RVEF, RVEDV and PCWP of the WBC group were superior to the HTK group at each post- operative time-point （P 〈 0.05 ）. Conclusion Protective effects of warm blood cardioplegia for right yentricular are superior to HTK in mitral valve surgery, especially for patients with preoperative right ventricu- lar dysfunction.