摘要
目的比较康斯特停搏液和冷含血停搏液在重症心脏瓣膜病患者手术中对心肌保护的效果。方法选取2012年3月至2014年3月在北京军区总医院心血管外科收治的46例重症心脏瓣膜病患者,均接受体外循环支持下心脏瓣膜直视手术,所有患者均无风湿活动及凝血功能障碍。将患者随机分为观察组和对照组,每组各23例。观察组术中给予康斯特停搏液,对照组给予冷含血停搏液。记录两组患者体外循环时间、主动脉阻断时间、心脏自动复跳率、术后心律失常发生率、血管活性药物用量、呼吸机辅助时间、监护室停留时间。分别于术前和术后4 h、12 h及24 h检测患者肌酸激酶同工酶和血清肌钙蛋白I的含量。结果术中两组患者体外循环时间、主动脉阻断时间、术后心律失常发生率、呼吸机辅助时间和监护室停留时间比较,差异无统计学意义(P均>0.05)。与对照组比较,观察组心脏自动复跳率升高(54.17%vs.79.17%),术后24 h多巴胺用量减少[(6.6±2.3)μg/(kg·min)vs.(5.2±2.1)μg/(kg·min)],差异有统计学意义(P均<0.05)。与对照组比较,观察组术后肌酸激酶同工酶4h[(49.7±11.8)IU/L vs.(24.5±2.0)IU/L]、12 h[(83.9±18.3)IU/L vs.(31.1±2.6)IU/L]、24 h[(62.4±12.5)IU/L vs.(32.4±3.3)IU/L]下降,差异有统计学意义(P均<0.05)。与对照组比较,观察组术后心肌肌钙蛋白I水平4 h[(1.20±0.13)μg/L vs.(0.21±0.04)μg/L]、12 h[(2.35±0.64)μg/L vs.(1.22±0.59)μg/L]、24 h[(1.75±0.24)μg/L vs.(0.76±0.41)μg/L]下降,差异有统计学意义(P均<0.05)。结论康斯特停搏液对重症心脏瓣膜病患者术中心肌保护作用优于冷含血停搏液。
Objective To compare the effects of Kangsite Cardioplegic Solution （histidine-triptophan- ketoglutalate solution, HTK Solution） and Lenghanxue Cardioplegic Solution in myocardial protection during surgery in patients with severe valvular heart disease. Methods The patients （n=46） undergone open-heart surgery supported by cardiopulmonary bypass （CPB） and without active rheumatism and coagulation disorders were chosen from Mar. 2012 to Mar. 2014. All patients were divided into observation group and control group （each n=23）, and observation group was given HTK Solution and control group, Lenghanxue Cardioplegic Solution. CPB time, aorta cross-clamping time, auto- rebeat rate, incidence of post-surgery arrhythmia, dosage of vasoactive drug, duration of mechanical ventilation time and ICU monitoring time were recorded in 2 groups. The levels of creatine kinase MB （CK-MB） and serum cardiac troponin T （cTnT） were detected respectively at different time points （before surgery, and 4 h, 12 h and 24 h after surgery）. Results The difference in CPB time, aorta cross-clamping time, incidence of post-surgery arrhythmia, duration of mechanical ventilation time and ICU monitoring time had no statistical significance between 2 groups during surgery （allP〉0.05）. Compared with control group, auto-reheat rate increased （54.17% vs. 79.17%） mad dosage of dopamine decreased after surgery for 24 h [（6.6 ± 2.3） μg/（kg· min） vs. （5.2 ± 2.1） μ g/（kg · min）, all P〈0.05] in observation group. Compared with control group, the level of CK-MB decreased after 4 h [（49.7 ± 11.8） IU/L vs. （24.5 ± 2.0） IU/L], 12 h [（83.9 ± 18.3） IU/L vs. （31.1 ± 2.6） IU/L] and 24 h [（62.4 ± 12.5） IU/L vs. （32.4 ± 3.3） IU/L, all P〈0.05] in observation group. Compared with control group, the level of cTnT decreased after surgery for 4 h [（1.20± 0.13） μ g/L vs. （0.21± 0.04） μg/L], 12 h [（2.35 ± 0.64） μ g/L vs. （1.22 ± 0.59） μ g/L] and 24 b [（1.75 ± 0.24） μ g/L vs. （0.76 ± 0.41） μg/L, all P〈0.05] in observation group. Conclusion The protective effect of HTK Solution on heart function is better than that of Lenghanxue Cardioplegic Solution during surgery in patients with severe valvular heart disease.
出处
《中国循证心血管医学杂志》
2015年第1期54-56,共3页
Chinese Journal of Evidence-Based Cardiovascular Medicine
关键词
重症心脏瓣膜病
康斯特停搏液
冷含血停搏液
心肌保护
Severe valvular heart disease
Kangsite Cardioplegic Solution
Lenghanxue CardioplegicSolution
Myocardial protection
