摘要
目的对比研究组氨酸-色氨酸-酮戊二酸(histidine-tryptophane-ketoglutarate,HTK)心肌保护液与4:1含血心脏停搏液对复杂冠状动脉病变合并左心功能不全患者外科血运重建手术时的心肌保护作用。方法2003年1月至2013年7月2 132例缺血性心脏病患者在我院行单纯冠状动脉旁路移植术,收集其中227例复杂冠状动脉病变合并左心功能不全患者的临床资料。全部患者为左主干或三支病变,左心室射血分数≤50%。按照术中使用的心脏停搏液分为HTK液组[n=89,男85例、女4例,年龄(62.78±9.30)岁]和含血心脏停搏液组[n=138,男113例、女25例,年龄(62.74±9.07)岁]。比较两种心脏停搏液的心肌保护效果。结果两组术前基线资料比较,除女性比例和肾功能不全外,其余差异均无统计学意义。HTK液组在体外循环时间及主动脉阻断时间方面显著长于含血心脏停搏液组。两组患者在住院死亡、低心排血量综合征等主要评价指标方面差异均无统计学意义。次要评价指标方面,HTK液组在停机后肺动脉压力及血管活性药物使用方面显著高于含血心脏停搏液组。结论对复杂冠状动脉病变合并左心功能不全患者,HTK液与4:1含血心脏停搏液均可提供安全有效的心肌保护效果。在心肌缺血时间延长的情况下,HTK液并未增加患者术后早期心血管不良事件的发生率。
Objective To retrospectively compare and analyze the effect of myocardial protection between histidinetryptophane-ketoglutarate （HTK） and 4：1 blood cardioplegia in patients with complex coronary artery disease and left ventricular dysfunction. Method From January 2003 to July 2013, 2132 patients underwent isolated coronary artery bypass grafting （CABG） in our institution. Among them, 227 patients with complex coronary artery disease （left main or triple vessel disease） and left ventricular dysfunction （ejection fraction ≤ 50%） were included in this study. According to the category of cardioplegia utilized in the operations, the patients were divided into two groups： a HTK group （85 males and 4 females, n=89） and a blood cardioplegia group （113 males and 25 females, n=138）. The average age was 62.78±9.30 years in the HTK group and 62.74±9.07 years in the blood cardioplegia group. The effect of myocardial protection between two groups was compared. Result According to the pre-operational data of these two groups, there was no significant difference identified in terms of basic characteristics and risk factors, even though more female patients were found in the blood cardiophegia group and more patients with renal dysfunction were found in the HTK group. In addition, the patients in the HTK group had more distal anastomosis, longer cardiopulmonary time and cross damping time than those in the blood cardiophegia group. Based on the results measured by those primary assessment criteria,there was no significant difference being found between these two groups. However, on those secondary assessment criteria the pulmonary pressure and inotropic support after reperfusion were significantly higher in the HTK group than its counterpart. Conclusion For patients with complex coronary artery disease and left ventricular dysfunction, HTK solution and blood cardioplegia provide similar effective myocardial protection. HTK doesn＇t significantly increase postoperative adverse cardiovascular events
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2016年第10期954-959,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
复杂冠状动脉病变
HTK液
含血心脏停搏液
心肌保护
左心功能不全
Complex coronary artery disease
HTK solution
Blood cardioplegia
Myocardial protection
Left ventricular dysfunction
