摘要
目的 观察del Nido停搏液在急性StanfordA型主动脉夹层外科手术中的心肌保护临床效果,探讨del Nido停搏液在成人大血管手术中应用的安全性和有效性.方法 回顾性分析2018年5月至2019年5月因急性StanfordA型主动脉夹层在本院行心脏外科手术的50例病例,按照术中心肌保护灌注液的不同分为两组:del Nido停搏液组(del Nido组,即DN组,24例)和高钾全血停搏液组(whole blood组,即WB组,26例).对两组患者术前一般资料、体外循环时间、主动脉阻断时间、停循环时间、停搏液用量、体外循环最低血红蛋白浓度、自动复跳率、术前术后血清肌钙蛋白Ⅰ (troponinⅠ,cTnⅠ)浓度、机械通气时间、监护室停留时间、术后并发症及预后情况等进行比较.结果 两组患者术前资料无统计学差异.两组术后各1例患者出现死亡,其中1例死于多器官功能衰竭,1例死于神经系统并发症.DN组患者术中停搏液晶体总量显著高于WB组[(1568±230)ml比(43±12)ml,P<0.05],DN组停搏液灌注次数显著低于WB组[(1.80±0.72)次比(5.23±0.81)次,P<0.05],DN组总灌注时间显著低于WB组[(6.23±0.39)min比(12.49± 1.02)min,P<0.05],其余各项术中、术后指标两组比较未见统计学差异.结论 del Nido停搏液在急性Stanford A型主动脉夹层外科手术中可以提供较好的心肌保护作用,临床效果良好.
Objective To observe the cardioprotective effects and clinical outcomes of del Nido cardioplegia during the surgical treatment of acute Stanford type A aortic dissection. Methods From May 2018 to May 2019, data of 50 cases in our hospital undergoing surgery of acute Stanford type A aortic dissection were reviewed. Patients were divided into two groups according to the intraoperative myocardial protective perfusate: del Ni d o cardioplegia group (DN group, n=24) and the high potassium whole blood cardioplegia group (W B group, n=26). Preoperative general data, cardiopulmonary bypass time, aortic occlusion time, time of deep hypothermic circulatory arrest, total volume of cardioplegia solution administered, minimum hemoglobin concentration during cardiopulmonary bypass, rate of non-defibrillation after coronary reperfusion, preoperative and postoperative serum troponin I(cTnl) concentration, mechanical ventilation time, intensive care unit stay time, postoperative complications and prognosis of two group's patients were compared. Results There was no significant difference in preoperative data between the two groups. One patient died after surgery in each group, of whom one died of multiple organ failure and the other died of neurological complications. The total volume of cardioplegia solution administered in DN group was significantly higher than that in WB group [(156 8±230)ml vs.(43±12)ml, P<0.05]. The number of cardioplegic perfusion in DN group was significantly lower than that in W B group[(1.80±0.72) vs.(5.23±0.81), P<0.05]. Total perfusion time in DN group was significantly lower than that in W B group [(6.23土0.39) min vs.(12.49± 1.02)min ,P<0.05]. There were not significant differences in other indexes between the two groups after the operation. Conclusion Del Nido cardioplegia can provide better myocardial protection in acute Stanford type A aortic dissection surgery.
作者
肖娟
刘梅
彭莉
陈祥舟
张秋霞
王咏
马瑞彦
肖颖彬
XIAO Juan;LIU Mei;PENG Li;CHEN Xiang-zhou;ZHANG Qiu-xia;WANG Yong;MA Rui-yan;XIAO Yingbin(Department of Cardiovascular Surgery, Second Affiliated Hospital of Army Military Medical University, Chongqing 400037, China)
出处
《中国心血管病研究》
CAS
2019年第9期818-821,共4页
Chinese Journal of Cardiovascular Research
