Del Nido心脏停搏液在成人心脏外科中的应用效果分析

Application of Del Nido Cardioplegia in Adult Cardiac Surgery

目的 评价del Nido心脏停搏液在成人心脏外科手术中的安全性及有效性,为成人心脏手术选择合适心肌保护液提供参考.方法 回顾性分析2018年1月至2019年1月我科95例应用del Nido心脏停搏液的临床资料.结果 本研究中男性47例(49.5%),年龄(55.0±17.6)岁,病因以心脏瓣膜病(64例,67.4%)为主,术前合并心房颤动26例(27.4%).体外循环时间(138.6±65.4)min,主动脉阻断时间(75.8±32.0) min,灌注次数(1.14±0.43)次,顺行灌注94例(98.9%),自动复跳86例(90.5%).转流最低肛温(33.3±2.7)℃,转流结束时乳酸值1.7(1.4~2.3) mmol/L.术后第2天cTnⅠ浓度3.3(1.8~5.7)ng/ml.呼吸机辅助时间24(18~67)h,ICU停留时间4(3~7)d,术后住院13(9~16)d.术后无卒中和新发心肌梗死,新发心房颤动26例(37.7%),胸腔积液14例(14.7%),二次开胸2例(2.1%),急性肾衰竭2例(2.1%),感染3例(3.2%).出院前最后一次LVEF较术前稍降低[(59.6±9.0)%比(62.4±8.7)%,P<0.01],围手术期死亡2例,与心脏停搏液无关.结论 del Nido心脏停搏液灌注次数少,未发现其对心肌的额外损伤,适合多种疾病的心肌保护.近期安全性、有效性良好,提高了手术操作的简便性.

Objective To evaluate the safety and efficacy of del Nido cardioplegia in adult cardiac surgery. Methods Ninety-five patients who received del Nido cardioplegia in our hospital from January 2018 to January 2019 were retrospectively reviewed. Results There were 47 males (49.5%) and the mean age were (55.0土 17.6) years. The main etiologywas valvular heart disease(64 cases, 67.4%) and 26 cases(27.4%) had atrial fibrillation before operation. T he cardiopulmonary bypass timewas ( 138.6±65.4) min and the aortic cross-clamping time was (75.8 土 32.0) min. The cardioplegia was given (1.14 土 0.43) times. Ninety-four cases (98.9%) had anterograde cardioplegia and 86 cases (90.5%) recovered to sinus rhythm spontaneously. The lowest rectal temperature w a s (33.3±2.7)℃ and the lactate value was 1.7( 1.4-2.3) m mol/L at the end of the cardiopulmonary bypass. T h e cTnl concentrationwas 3.3(1.8-5.7)ng/ml on the 2nd postoperative day. The ventilation time was 2 4 ( 18-67)h, while the ICU residential time was 4 (3-7) days and the postoperative hospital stay was 13 (9-16) days. Therewas no stroke or new myocardial infarction after operation, while 26 cases (37.7%) had new atrial fibrillation and 14 cases (14.7%) had pleural effusion. There were 2 patients (2.1%) with re-exploration and 2 patients (2.1%) with acute renal failure and 3 patients (3.2%) with infection. Compared with the preoperative ejection fraction, the latest ejection fraction before dischargewas reduced[(59.6±9.0)% vs.( 62.4±8.7)%,P<0.01]. Two patients died during the perioperative period whichwas not directly related to cardioplegia. Conclusion Del Nido cardioplegia is given less frequently and not induce additional damage to the myocardium. It is applicable to myocardial protection in a variety of heart diseases in adults. It is safe and effective and improves the convenience of the cardiac surgery.