HTK液与冷血停搏液在心脏瓣膜手术中应用对比:倾向得分匹配分析

Histidine-Tryptophan-Ketoglutarate Solution Versus Cold Blood Cardioplegia in Cardiac Valve Surgery:A Propensity-Score Matched Analysis

目的:比较HTK液与冷血停搏液在心脏瓣膜手术中应用效果,为临床心肌保护灌注策略提供依据。方法:采用单中心数据回顾性分析,选取2015年5月-2018年8月在体外循环下(CPB, Cardiopulmonary Bypass)应用灌注停跳液停跳的瓣膜手术患者529例,分为冷停液组(n=326)及HTK液组(n=203),采用倾向得分匹配方法将上述两组资料进行匹配,确定选取73对可匹配病例进行比较。采集的临床结果主要为CPB时间,阻断时间,ICU停留时间(intensive care unit length of stay,ICU LOS)以及血清钠术中术后浓度变化等参数。其次为,术后呼吸机辅助时间,IABP(Intra aortic ballon pump)的使用及新发透析,30天死亡率与术后主要并发症情况。结果:匹配后两组中冷停液组较HTK液组的主动脉平均阻断时间及CPB时间长,差异具有统计学意义(P<0.05),HTK液组存在短暂性低血钠血症(P<0.05),ICU LOS以及其余各临床结果无显著差异。结论:心脏瓣膜手术中应用HTK液与冷血停搏液临床早期结果一致,可根据手术操作流程及病人经济水平进行合理选择。

Objective:To compare the effects of Histidine-Tryptophan-Ketoglutarate Solution and Cold blood cardioplegia in valve surgery,and provide evidence for clinical myocardial protection perfusion strategy.Methods:A retrospective analysis of singlecenter data was used to select 529 patients with valve surgery who underwent cardiopulmonary bypass(CPB)from May 2015 to August 2018.Divided into cold blood cardioplegia group(n=326)and HTK solution group(n=203).Propensity score matching was used to adjust for differences between the two groups,and 73 matched pairs were identified.The primary end point was CPB time,aortic block time,ICU(intensive care unit)length of stay(LOS),and intraoperative changes in serum sodium concentration.Secondary end point included postoperative ventilator assist time,the use of IABP(Intraaortic ballon pump)and new dialysis,30-day mortality and major postoperative complications.Results:For the matched,the average aortic block time and CPB time of the cold blood cardioplegia group was longer than HTK solution group,and the difference was statistically significant(P<0.05).There was acute transient hyponatremia in the HTK group(P<0.05),and there was no significant difference in ICU LOS and other clinical outcomes.Conclusions:During cardiac valve surgery,both cardioplegia techniques were consistent in the early clinical results,which can be selected according to the surgical procedure and the patient’s economic level.