Del Nido停搏液在成人心脏瓣膜手术中的多脏器保护效果研究
Multi-organ protective effects of del Nido cardioplegia in adult cardiac valve surgery
张婷婷 1陈巍 2刘畅 3田海 4啜俊波4
作者信息
- 1. 哈尔滨医科大学附属第二医院心血管外科
- 2. 哈尔滨医科大学附属第二医院心血管外科;哈尔滨医科大学附属第二医院未来医学实验室;中国遗传资源保护与疾病防控教育部重点实验室,黑龙江哈尔滨 150081
- 3. 哈尔滨医科大学附属第二医院未来医学实验室
- 4. 哈尔滨医科大学附属第二医院心血管外科;哈尔滨医科大学附属第二医院未来医学实验室
- 折叠
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 troponin Ⅰ,cTn Ⅰ)、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,PO2)、二氧化碳分压(partial pressure of carbon dioxide,PCO2)等指标.结果 两组 cTn Ⅰ、CKMB、肌酐、BUN、PO2、PCO2 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)o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.
Abstract
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(cTnl),creatine kinase MB(CKMB),creatinine,blood urea nitrogen(BUN),partial pres-sure of oxygen(PO2),partial pressure of carbon dioxide(PCO2),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,PO2,PCO2,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.
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Key words
cardiopulmonary bypass/del Nido cardioplegia/valve replacement surgery/myo-cardial protection/acute kidney injury引用本文复制引用
基金项目
吴阶平医学基金会临床科研专项(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基金(LPHGRD2022-002)
出版年
2024
NETL
NSTL
万方数据