del Nido停搏液在成人二尖瓣联合三尖瓣成形手术中的应用

Application of del Nido cardioplegia in adult mitral and tricuspid valvuloplasty

目的比较del Nido停搏液与含血停搏液在成人二尖瓣联合三尖瓣成形手术中的初步临床效果。方法收集2019年1月至2020年8月在本院心肺转流(CPB)下进行成人二尖瓣联合三尖瓣成形手术的患者63例,根据术中使用的心脏停搏液种类分为观察组30例,对照组33例,观察组术中应用del Nido停搏液,对照组术中应用含血停搏液(血液与晶体比例为4∶1)。采集并记录术前、CPB 30 min,停机后1 h、术后24 h的血红蛋白(Hb)浓度,红细胞压积(HCT),血钾离子(K^(+))以及乳酸(Lac)情况;术前及术后24 h的肌钙蛋白I(cTnI),心肌型肌酸激酶同工酶(CKMB)的浓度及肌酐水平;CPB时间、主动脉阻断时间、停搏液灌注次数、停搏液总量、晶体灌注量及心脏自动复跳率;术后24 h血管活性药物评分、呼吸机辅助时间、ICU住院时间、术后住院时间及并发症的情况。结果两组患者年龄、体重、性别、合并症、术后24 h血管活性药物评分、呼吸机辅助时间、ICU住院时间、术后住院时间以及术前和术后24 h血肌酐、cTnI、CKMB、Hb、HCT、血K^(+)、Lac等组间均无显著差异(P>0.05);两组术后均无脑血管意外、肾衰竭及低心排血量综合征等相关并发症;与对照组比较,观察组灌注停搏液的总量、灌注次数、CPB时间、主动脉阻断时间、CPB 30 min Hb、HCT、血K^(+)均减少,具有统计学差异(P<0.05),心脏自动复跳率及晶体灌注量均增加(P<0.05)。结论在成人二尖瓣联合三尖瓣成形手术中,del Nido停搏液与含血停搏液心肌保护效果无显著差异;del Nido停搏液可以缩短CPB时间及主动脉阻断时间。

Objective To compare the clinical effect of del Nido cardioplegia and blood cardioplegia in adult mitral and tricuspid valvuloplasty.Methods From January 2019 to August 2020,63 adult patients with mitral and tricuspid valvuloplasty under cardiopulmonary bypass(CPB)in our hospital were collected.According to the types of myocardial cardioplegia used during the operation,they were divided into observation group(del Nido cardioplegia,n=30)and control group(blood cardioplegia,n=33 cases).Hemoglobin concentration(Hb),hematocrit(HCT),blood potassium(K^(+))and lactic acid(Lac)were collected and recorded preoperatively,30 minutes after CPB,1 hour after CPB and 24 hours after operation.The levels of cTnI,CKMB and creatinine(Cr)were measured before and 24 hours after operation.CPB time,aortic clamping time,cardioplegia perfusion times,total cardioplegia volume,crystalloid perfusion volume and the rate of automatic heart resuscitation were measured.24 h postoperative vasoactive drugs score,ventilation time,the length of ICU stay,the length of postoperative hospital stay and complications were analyzed.Results There were no significant differences in age,weight,gender,complications,vasoactive drug score 24 h postoperatively,ventilation time,length of ICU stay,length of postoperative hospital stay,serum Cr,cTnI,CKMB,Hb,HCT,blood K^(+),Lac between the two groups(P>0.05).There were no postoperative complications such as cerebrovascular accident,renal failure and low cardiac output in both groups.Compared with the control group,the total amount of cardioplegia,perfusion times,CPB time,aortic clamping time and the level of Hb,HCT,and blood K^(+)at 30 minutes after CPB in the observation group significantly decreased(P<0.05),while the rate of automatic heart resuscitation and the volume of crystal perfusion were increased significantly(P<0.05).Conclusion There was no significant difference in myocardial protection between del Nido and blood cardioplegia in adult mitral and tricuspid valvuloplasty.Del Nido cardioplegia could shorten CPB time and aortic clamping time.