Del Nido停搏液在重症心脏瓣膜手术中安全性和有效性分析

Analysis of the safety and efficacy of Del Nido cardioplegia in severe cardiac valve surgery

目的 Del Nido心肌停搏液作为近20年出现的一种停搏液,在成人心脏外科获得了良好的评价。文中探讨Del Nido停搏液在重症心脏瓣膜手术中的心肌保护效果,为体外循环中的心肌保护提供临床依据。方法回顾性分析2017年1月至2019年6月在南通大学附属医院施行瓣膜手术的90例重症心脏瓣膜病患者临床资料。其中使用Del Nido停搏液的患者45例(DN组),同期使用传统含血停搏液的患者45例(TC组)。记录2组患者体外循环过程中体外循环时间、主动脉阻断时间、辅助循环时间、心肌停搏液灌注次数及总量和自动复跳率,以及体外循环术后24 h乳酸脱氢酶(LDH)指标、24 h肌钙蛋白I(cTnI)指标、24 h引流量及输血量,呼吸机撤除时间和ICU时间,并对2组患者术后24 h血管活性药物使用评分(VIS)进行比较。结果 2组患者年龄、体重、术前LDH、术前cTnI、体外循环时间、主动脉阻断时间、辅助循环时间、呼吸机撤离时间及ICU时间差异均无统计学意义(P>0.05)。DN组较TC组,灌注次数减少[(1.49±0.51)次vs(6.29±0.92)次],灌注总量降低[(111.11±162.68)mL vs(160.00±387.88)mL],心脏自动复跳率增高(77.78%vs 53.33%),差异均有统计学意义(P<0.05)。术后24 h,DN组较TC组LDH[(358.00±124.29)U/L vs(439.82±122.00)U/L]和cTnI降低[(1.92±0.89)μg/L vs(2.53±1.59)μg/L],引流量减少[(264.00±125.31)mL vs(345.22±151.72)mL],输血总量降低[(737.00±195.77)mL vs(825.56±111.99)mL],差异均有统计学意义(P<0.05)。DN组患者血管活性药物评分(VIS)显著低于TC组[(4.99±2.10)vs(5.87±1.56)],差异有统计学意义(P<0.05)。结论在重症瓣膜手术中,应用Del Nido停搏液可以较好地发挥心肌保护作用,同时在术后早期对重症心肌损伤也能起到更好的恢复作用。

Objective As a kind of cardioplegia solution, Del Nido has been well evaluated in adult cardiac surgery. In this paper, the myocardial protective effect of Del Nido cardioplegic solution in severe cardiac valve surgery was discussed to provide clinical basis for myocardial protection in cardiopulmonary bypass. Methods Retrospective analysis was performed on the clinical data of 90 patients with severe cardiac valvular disease who underwent valve surgery in The Affiliated Hospital of Nantong University from January 2017 to June 2019. Among them, 45 patients were treated with Del Nido cardioplegia(DN group), and 45 patients were treated with traditional cardioplegia(TC group) during the same period. We recorded the data of 2 groups of patients in the process of extracorporeal circulation: extracorporeal circulation time, aorta blocking time, auxiliary circulation time, cardiac arrest fluid infusion rate, its total amount and automatic recovery rate and lactate dehydrogenase(LDH) 24 h after extracorporeal circulation, 24 h troponin I(cTnI) index, 24 h drainage and transfusion volume, ventilator removal time and ICU time, and we also compared the vasoactive-inotropic score(VIS) 24 h after surgery between the two groups. Results There were no statistically significant differences in age, weight, preoperative LDH, preoperative cTnI, extracorporeal circulation time, aortic blocking time, auxiliary circulation time, ventilator removal time and ICU time between the two groups(P>0.05). DN group has less perfusion times [(1.49±0.51) vs(6.29±0.92) times], reduced perfusion amount [(111.11±162.68)mL vs(160.00±387.88)mL], and increased automatic recovery rate(77.78% vs 53.33%) than TC group, and all these differences had statistical significance(P<0.05). 24 h postoperatively, LDH [(358.00±124.29)U/L vs(439.82±122.00)U/L] and cTnI [(1.92±0.89) g/L vs(2.53±1.59) g/L] were reduced in DN group compared with TC group, the drainage volume was decreased [(264.00±125.31)mL vs(345.22±151.72)mL, and the total volume of transfusion was decreased [(737.00±195.77)mL vs(825.56±111.99)mL], respectively. The differences were statistically significant(P<0.05). The vasoactive-inotropic score(VIS) in DN group was significantly lower than that in TC group [(4.99±2.10) vs(5.87±1.56)], and the difference was statistically significant(P<0.05). Conclusion In critical valve surgery, Del Nido plays an important part in myocardial protection and the recovery of severe myocardial injury in the early postoperative period.