国产HTK液与4:1含血停搏液在双瓣膜置换术心肌保护的效果观察

Observation on Effect of Domestic HTK Solution and 4:1 Blood Cardioplegic Solution on Myocardial Protection in Double Valve Replacement

目的:对比国产HTK液与4∶1含血停搏液在体外循环(CPB)下心脏双瓣膜置换术心肌保护效果差异性。方法:选择2018年7月-2020年8月广州医科大学附属第六医院在CPB下实施双瓣膜置换术治疗的52例,年龄22~68岁患者,用阿拉伯数字编号,单数号为H组(n=26),采用单次灌注国产HTK液作为心肌保护液,诱导心脏停搏;双数号为G组(n=26),采用多次灌注4∶1含血停搏液。分别在围术期不同时点采集血液检测相关临床指标,记录升主动脉开放后需除颤次数、心律失常发生率、血管活性药物使用量等临床其他指标。结果:两组心脏自动复跳率、呼吸机辅助时间、ICU停留时间比较,差异均无统计学意义(P>0.05);两组体外循环时间、升主动脉阻断时间、灌注次数、多巴胺用量比较,差异均有统计学意义(P<0.05)。两组T_(1)时CK-MB水平和T_(4)时cTnI水平比较,差异均无统计学意义(P>0.05);H组T_(2)、T_(3)、T_(4)时CK-MB水平均低于G组,H组T_(2)、T_(3)时cTnI均低于G组,差异均有统计学意义(P<0.05)。结论:两种心肌保护液在心脏双瓣膜置换术中均具有较好的心肌保护,对比4∶1含血停搏液国产HTK液具有更好的心肌保护效果。

Objective:To compare the myocardial protective effect of domestic HTK solution and 4∶1 blood cardioplegic solution in double valve replacement under cardiopulmonary bypass(CPB).Method:From July 2018 to August 2020,52 patients aged 22-60 years treated with double valve replacement under CPB in the Sixth Affiliated Hospital of Guangzhou Medical University were selected,numbered with Arabic numerals,the odd number was group H(n=26),were treated with single infusion of domestic HTK solution as myocardial protective solution to induce cardiac arrest;the odd number was group G(n=26),were treated with 4∶1 blood cardioplegic solution.Blood samples were collected at different time points during the perioperative period to detect the relevant clinical indexes,as well as other clinical indicators such as the number of defibrillation after the opening of the ascending aorta,the incidence of arrhythmia and the use of vasoactive drugs were recorded.Result:There were no significant differences in rate of cardiac automatic re beats,ventilator assistance time,length of ICU stay between two groups(P>0.05).There were significant differences in the cardiopulmonary bypass time,ascending aorta blocking time,number of perfusionsand amount of Dopamine used between two groups(P<0.05).There were no significant differences in CK-MB level at T_(1)and cTnI level at T_(4)between two groups(P>0.05).The levels of CK-MB at T_(2),T_(3)and T_(4)in group H were lower than those in group G,and cTnI at T_(2)and T_(3)in group H were lower than those in group G(P<0.05).Conclusion:Two kinds of myocardial protective solution have better myocardial protection in double valve replacement,and domestic HTK solution has better myocardial protective effect compared with 4∶1 blood cardioplegic solution.