摘要
目的 比较del Nido停搏液(del Nido cardioplegia, DNC)与传统4∶1冷血停搏液(cold blood cardioplegia, CBC)在成人心脏瓣膜置换手术中的心肌保护效果及对肺肾功能的影响。方法 收集2021年8月~2022年8月哈尔滨医科大学附属第二医院在体外循环下行心脏瓣膜手术患者60例,分为DNC组(n=32)与CBC(n=28)组。比较两组患者术前(T0)、术后1 h(T1)、术后24 h(T2)的肌钙蛋白Ⅰ(cardiac troponinⅠ,cTnⅠ)、肌酸激酶同工酶(creatine kinase MB,CKMB)、血肌酐(serum creatinine, sCr)、尿素氮(blood urea nitrogen, BUN)、氧分压(partial pressure of oxygen, PO_(2))、二氧化碳分压(partial pressure of carbon dioxide, PCO_(2))等指标。结果 两组cTnⅠ、CKMB、肌酐、BUN、PO_(2)、PCO_(2)比较无差异。手术死亡率、各种并发症发生率及其他指标无显著差异。DNC组的停搏液使用总量、体外循环(cardio-pulmonary bypass, CPB)时间及主动脉阻断时间均少于CBC组(P<0.05)。低体重患者(≤55 kg)DNC组输血量高于CBC组(P<0.05)。结论 DNC与CBC相比在心肌保护效果方面相似,适用于心脏瓣膜置换手术,可缩短阻断时间、循环时间,不影响肺肾功能。但贫血或低体重患者应采用低预充或改良超滤等方式来减少DNC造成血液稀释的影响。
Objective To compare the myocardial protective effects and impacts on the lungs and kidneys between del Nido cardioplegia(DNC)and traditional 4∶1 cold blood cardioplegia(CBC)in adult cardiac valve replacement surgery.Methods A retrospective analysis was conducted on 60 adult patients who underwent cardiac valve surgery with cardiopulmonary by⁃pass(CPB)between August 2021 and August 2022 at our hospital.The patients were divided into two groups:DNC group(n=32)and CBC group(n=28).The levels of cardiac troponin I(cTnI),creatine kinase MB(CKMB),creatinine,blood urea nitrogen(BUN),partial pres⁃sure of oxygen(PO_(2)),partial pressure of carbon dioxide(PCO_(2)),and other indicators were compared between the two groups at pre⁃operation(T0),1⁃hour post⁃operation(T1),and 24 hours post⁃operation(T2).Results There were no significant differences in cTnI,CKMB,creatinine,BUN,PO_(2),PCO_(2),surgical mortality rate,complication rate,and other indicators between the two groups.The total usage of cardioplegia solution,CPB time,and aortic cross⁃clamp time were significantly lower in the DNC group compared to the CBC group(P<0.05).Among patients with low body weight(≤55 kg),the DNC group required higher blood transfu⁃sion volumes than the CBC group(P<0.05).Conclusion DNC and CBC have similar myo⁃cardial protective effects and are suitable for cardiac valve replacement surgery.They can re⁃duce cross⁃clamp and bypass times without affecting lung and kidney functions.However,for anemic or low body weight patients,strategies such as reduced priming or modified ultrafiltra⁃tion should be considered to mitigate the effects of blood dilution caused by DNC.
作者
张婷婷
陈巍
刘畅
田海
啜俊波
ZHANG Ting-ting;CHEN Wei;LIU Chang;TIAN Hai;CHUAI Jun-bo(Department of Cardiovascular Surgery,Harbin 150081,China;Future Medical Laboratory,The Second Affiliated Hospital of Harbin Medical University,Harbin 150081,China;Key Laboratory of Preservation of Human Genetic Resources and Disease Control in China,Harbin 150081,China)
出处
《哈尔滨医科大学学报》
CAS
2024年第1期20-25,30,共7页
Journal of Harbin Medical University
基金
吴阶平医学基金会临床科研专项资助基金(320.6750.2022-11-26)
中国遗传资源保护与疾病防控教育部重点实验室开放课题(LPHGRD2022-002)。
关键词
体外循环
del
Nido停搏液
瓣膜置换术
心肌保护
急性肾损伤
cardiopulmonary bypass
del Nido cardioplegia
valve replacement surgery
myocardial protection
acute kidney injury
