康斯特保护液与含血停搏液在肥厚型梗阻性心肌病术中的心肌保护效果

The cardioprotective effects of histidine-tryptophan-ketoglutarate solution and conventional blood cardioplegia in patients with hypertrophic obstructive cardiomyopathy undergoing surgical myectomy

目的:评价康斯特心肌保护液(histidine-tryptophan-ketoglutarate solution,HTK)与含血停搏液在肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)外科手术中的心肌保护效果。方法:回顾性分析首都医科大学附属北京安贞医院,2015年1月至2021年12月间,心脏外科HOCM行外科手术治疗患者临床资料,按照术中使用停搏液不同,分为HTK液组(HG,n=200)和含血停跳液组(BG,n=118),比较两组患者手术情况和术后恢复情况。结果:5例(1.6%)患者住院死亡,其中4例(2.0%)为HG组,1例(0.9%)为BG组,差异无统计学意义(P>0.05)。HG组患者术中平均阻断升主动脉时间[81(76,103)vs.76.6(49,88)min]和体外循环转机时间[118.5(92,152)vs.112.5(78,134)min]均稍长,但差异无统计学意义(P>0.05);HG组患者自动复跳率较低(29.0%vs.56.8%,P<0.01)。HG组患者术后平均肾上腺素使用时间较BG组短[15.7(0,18)vs.27.6(0,28)h,P=0.025];与BG组患者相比较,HG组患者术后ICU停留时间较短[30.6(16.0,29.0)vs.40.9(18.0,38.5)h,P=0.015]。结论:HTK液与含血停跳液均可安全用于HOCM患者外科手术,尽管HTK液组患者开放升主动脉后自动复跳率较低,但有较好心肌保护效果,能有效促进患者术后恢复。

Objective:To evaluate the myocardial protective effect of histidine-tryptophan-ketoglutarate solution(HTK)solution and cold blood-containing cardioplegia in patients with hypertrophic obstructive cardiomyopathy(HOCM)underwent surgical myectomy procedure.Methods:A retrospective analysis of adult patients undergoing surgical treatment of HOCM in cardiac surgery between January 2015 and December 2021 in Beijing Anzhen Hospital affiliated to Capital Medical University was conducted.The patients were divided into two groups according to the intraoperative use of cardioplegia:the HTK solution group(HG,n=200)and the blood-containing cardioplegia group(BG,n=118).Results:Five patients(1.6%)died in hospital,four patients(2.0%)were in the HG group and one patient(0.9%)was in the BG group,the difference was not statistically significant(P>0.05).The time of aortic clamping[81(76,103)vs.76.6(49,88)min]and cardiopulmonary bypass[118.5(92,152)vs.112.5(78,134)min]in the HTK group were slightly longer,but the difference was not statistically significant(P>0.05).The HTK solution group has a lower rate of the heart restarted spontaneously after declamping the ascending aortic(29.0%vs.56.8%,P<0.01).The mean postoperative adrenaline use time was shorter in the HG group than in the BG group[15.7(0,18)vs.27.6(0,28)h,P=0.025].Compared with patients in the BG group,the duration of ICU stayed in the HG group was shorter[30.6(16.0,29.0)vs.40.9(18.0,38.5)h,P=0.015].Conclusions:Both HTK solution and blood-containing cardioplegia can be safely used in HOCM patients underwent surgical myectomy.Although the HTK solution group has a lower rate of the heart restarted spontaneously after declamping the ascending aortic,it can provide better myocardial protection and promote postoperative recovery.