摘要
目的回顾性分析常温体外循环(cardiopulmonary bypass,CPB)与低温CPB使用del Nido停搏液在成人心脏瓣膜手术中的应用效果。方法回顾性分析2019年1月至2020年12月在广东省人民医院行心肺转流下心脏直视手术的77例成人患者的临床资料。入选患者均在CPB中使用del Nido停搏液进行心肌保护,按照CPB温度管理分成两组,常温组(≥35℃)39例,低温组(31~32℃)38例。观察两组患者手术时间、CPB时间及主动脉阻断时间;同时收集患者心肌损伤标志物及患者预后情况进行比较。结果常温组患者的手术时间、CPB时间及主动脉阻断时间明显低于低温组,差异有统计学意义(P<0.001)。与低温组患者相比,常温组患者在手术方式、除颤情况、术后机械通气时间、重症监护时间、术后正性肌力药物评分(vasoactive inotropic score,VIS)、术后24 h的左心室射血分数(left ventricular ejection fraction,LVEF)、术后住院时间、围术期死亡、术后恶性心律失常、术后低心排血量综合征等均差异无统计学意义(P>0.05)。同时,两组患者围术期血清超敏肌钙蛋白T(hs-cTnT)、肌酸激酶同工酶(CK-MB)、肌酸激酶(CK)及乳酸脱氢酶(LDH)浓度比较,差异无统计学意义(P>0.05)。结论del Nido停搏液应用在常温CPB可明显缩短手术时间、CPB时间及阻断时间;与低温下CPB手术相比,常温下应用del Nido停搏液同样具有心肌保护效果。
Objectives To retrospectively analyze the myocardial protection of del Nido cardioplegia during normothermic and hypothermic cardiopulmonary bypass(CPB)in adult valve surgery.Methods A total of 77 adult patients undergoing CPB open heart surgery from January 2019 to December 2020 in Guangdong Provincial People’s Hospital were included in this study.Del Nido cardioplegia was delivered for myocardial protection.According to the CPB temperature management,39 patients were in normothermi group(≥35℃)and 38 patients were in hypothermic group(31-32℃).The operation duration,CPB duration and aortic cross-clamping duration of the two groups were observed.At the same time,myocardial injury markers and prognosis of the patients were collected for statistical analysis.Results The operation duration,CPB duration and aortic cross-clamping duration in normothermic group were significantly shorter than those in hypothermic group(P<0.001).Compared with hypothermic group,there were no differences in surgical methods,defibrillation,postoperative mechanical ventilation duration,duration of intensive care,postoperative vasoactive inotropic score(VIS)score,24 h postoperative left ventricular ejection fraction(LVEF),postoperative length of hospital stay,perioperative death,postoperative malignant arrhythmia and postoperative low cardiac output syndrome in normothermic group(P>0.05).At the same time,there were no differences in perioperative serum concentrations of high sensitivity cardiac troponin T(hs-cTnT),creatine kinase isoenzyme MB(CK-MB),creatine kinase(C.K)and lactate dehydrogenase(LDH)between the two groups.Conclusions Del Nido cardioplegia significantly shortens the operation duration,CPB duration and aortic cross-clamping duration.Del Nido cardioplegia is effective in terms of myocardial protection during normothermic and hypothermic CPB in adult valve surgery.
作者
高民泰
崔俊吉
黄宏前
司徒宝凤
曾庆诗
GAO Min-tai;CUI Jun-ji;HUANG Hong-qian;SITU Bao-feng;ZENG Qing-shi(Department of Cardiac Surgery,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)
出处
《岭南心血管病杂志》
CAS
2022年第3期209-213,共5页
South China Journal of Cardiovascular Diseases
关键词
del
Nido停搏液
常温
体外循环
心肌保护
心脏瓣膜手术
del Nido cardioplegia
normothermia
cardiopulmonary bypass
cardiac protection
heart valve surgery
