Del Nido液联合磷酸肌酸钠在成人心脏瓣膜术中的应用效果分析

Analysis of application effect of Del Nido myocardial protective solution combined with creatine phosphate sodium in adult heart valve surgery

目的评价Del Nido液联合磷酸肌酸钠在成人心脏瓣膜术中的临床应用效果。方法60例行成人心脏瓣膜术患者,按照术中使用心肌保护液不同分为D组和T组,每组30例。D组顺灌Del Nido液+磷酸肌酸钠,T组顺灌St.Thomas液+磷酸肌酸钠,两组患者均在心脏停跳心内直视下行瓣膜手术。比较两组患者术中相关指标(升主动脉阻断时间、灌注量、灌注次数、自动复跳率、术后并发症发生率、围术期死亡情况)以及手术前后血浆肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)。结果D组患者升主动脉阻断时间(106.90±29.47)min短于对照组的(123.83±35.45)min,灌注量(1257.33±370.93)ml、灌注次数(1.63±0.67)次少于T组的(2630.00±873.25)ml、(3.77±1.14)次,有统计学差异(P<0.05);两组患者自动复跳率、术后并发症发生率及围术期死亡率比较无统计学差异(P>0.05)。两组患者术后即刻cTnI水平均有明显上升,术后48 h明显出现下降,组内比较有统计学差异(P<0.05),但组间无统计学差异(P>0.05)。两组患者术后即刻CK-MB水平均有明显上升,术后48 h明显出现下降,组内比较有统计学差异(P<0.05),但组间无统计学差异(P>0.05)。结论Del Nido液联合磷酸肌酸钠可安全应用于成人心脏瓣膜术中,不仅能为心肌提供良好的保护效果,而且能明显减少灌注的次数,缩短升主动脉阻断时间。

Objective To evaluate the clinical effect of Del Nido myocardial protective solution combined with creatine phosphate sodium in adult heart valve surgery.Methods A total of 60 cases of adult heart valve surgery were divided into group D and group T according to the difference of myoprotective fluid.Group D received Del Nido myocardial protective solution plus creatine phosphate sodium,group T received St.Thomas myocardial protective solution plus creatine phosphate sodium,and both groups underwent valve surgery under direct intracardiac visualization in cardiac arrest.The intraoperative related indicators(aortic clamping time,perfusion volume,number of perfusions,auto-cardiac resuscitation rate,incidence of postoperative complications,perioperative mortality)and cardiac troponin I(cTnI)and creatine kinase isoenzyme(CK-MB)before and after surgery were compared between the two groups.Results Group D had shorter aortic clamping time of(106.90±29.47)min than(123.83±33.45)min in group T;group D had perfusion volume of(1257.33±370.93)ml and number of perfusions of(1.63±0.67)times,which were less than(2630.00±873.25)ml and(3.77±1.14)times in group T.The difference was statistically significant between the two groups(P<0.05).There were no significant differences in the auto-cardiac resuscitation rate,incidence of postoperative complications and perioperative mortality between the two groups(P>0.05).The levels of cTnI in both groups were significantly increased immediately after surgery,and significantly decreased 48 h after surgery,there was statistical difference within groups(P<0.05),but no difference between groups(P>0.05).The levels of CK-MB in both groups were significantly increased immediately after surgery,and significantly decreased 48 h after surgery,there was statistical differenc within groups(P<0.05),but no difference between groups(P>0.05).Conclusion Del Nido myocardial protective solution combined with creatine phosphate sodium can be safely applied to adult heart valve surgery,which can not only provide good protection effect for myocardium,but also significantly reduce the number of perfusions and shorten the time of ascending aortic occlusion.