两种心脏停搏液在体外循环下单纯心脏瓣膜置换术中的心肌保护效果

Protective effects of HTK solution and blood St.Thomas solution on myocardium in patients undergoing cardiac valve replacement under cardiopulmonary bypass

目的:比较两种心脏停搏液在体外循环下单纯心脏瓣膜置换术中的心肌保护效果。方法:将2019年5月至2022年7月四川省人民医院收治的108例单纯心脏瓣膜置换术患者分为两组,A组53例,使用组氨酸-色氨酸-酮戊二酸(HTK)液;B组55例,使用含血St.Thomas液。比较两组体外循环术中情况如体外循环时间、主动脉阻断时间、灌注次数、心脏复跳时间、心脏自动复跳率,主动脉阻断前以及术后2、12、24、48、72 h时血清肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶同工酶(CK-MB)、脑钠肽(BNP)、心型脂肪酸结合蛋白(HFABP)、丙二醛(MDA)、超氧化物歧化酶(SOD)水平,转流过程中血K^(+)、Na^(+)浓度,手术前后心排量与心指数,术后24 h多巴胺的用量及并发症等。结果:A、B组体外循环时间、主动脉阻断时间差异无统计学意义(P>0.05),A组灌注次数少于B组,心脏复跳时间短于B组,心脏自动复跳率高于B组(P<0.05);A组术后2、12、24、48 h时血清cTnⅠ、CK-MB、BNP、HFABP、MDA水平低于B组,SOD水平高于B组(P<0.05);A组转流中、转流后即刻血K^(+)、Na^(+)水平低于B组(P<0.05);A组术后12、24 h心排量与心指数高于B组(P<0.05);A组术后24 h多巴胺用量少于B组(P<0.05)。两组术后并发症发生率差异无统计学意义(13.2%vs 21.8%,P=0.240)。结论:相较于含血St.Thomas液,HTK液应用于体外循环下单纯心脏瓣膜置换术,心肌保护效果更佳。

Aim:To compare the effects of histidine-tryptophan-ketoglutarate(HTK)solution and blood St.Thomas solution on myocardium in patients undergoing cardiac valve replacement under cardiopulmonary bypass.Methods:A retrospective analysis was performed on 108 patients undergoing cardiac valve replacement in Sichuan People′s Hospital between May 2019 and July 2022.According to different myocardial protection solution,they were allocated into group A(n=53,HTK solution)and group B(n=55,blood St.Thomas solution).The myocardial protection indexes in the 2 groups were compared.Results:There was no significant differences in cardiopulmonary bypass time or aortic occlusion time(P>0.05).Compared with group B,the perfusion times were fewer,heart rebeat time was shorter,and heart automatic rebeat rate was higher in group A(P<0.05).At 2,12,24 and 48 hours after surgery,levels of serum cardiac troponinⅠ,creatine kinase MB,brain natriuretic peptide,heart fatty acid-binding protein and malondialdehyde were lower in group A than those in group B,while level of superoxide dismutase was higher in group A(P<0.05).During and immediately after bypass,levels of blood K^(+)and Na^(+)were lower in group A than those in group B(P<0.05).At 12 and 24 hours after surgery,cardiac output and cardiac index were higher in group A than those in group B(P<0.05).Within 24 hours after surgery,dosage of dopamine was fewer in group A than that in group B(P<0.05).The incidence of complications in group A and group B had no significant difference(13.2%vs 21.8%,P=0.240).Conclusion:Compared with blood St.Thomas solution,HTK solution has better myocardial protection effects in patients undergoing cardiac valve replacement under cardiopulmonary bypass.