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投稿时间：2019-01-05 网络发布日期：2019-06-21
投稿时间：2019-01-05 网络发布日期：2019-06-21
中文摘要: 目的 比较Del Nido停搏液、HTK停搏液与改良 St.Thomas停搏液三种不同心肌保护液在心脏瓣膜置换术中的心肌保护效果。方法 回顾性分析2016年1月至2018年12月行体外循环(CPB)下瓣膜置换术的120例患者的临床资料,按照使用心肌保护液的不同分为三组:Del Nido停搏液组40例患者，HTK停搏液组40例患者，改良St.Thomas停搏液组40例患者。收集CPB时间、主动脉阻断时间、停搏液灌注次数、自动复跳率、除颤率、术后24 h和术后72 h外周血肌钙蛋白I(cTnI) 和肌酸磷酸激酶同工酶(CK-MB)浓度、术后正性肌力药使用天数、气管插管时间、入住重症监护室时间、术后住院天数、停跳液治疗费用、术后射血分数（EF）等临床资料。结果 三组患者性别、年龄、体重、术前射血分数等基本资料差异无统计学意义(P>0.05)；三组患者均顺利完成瓣膜置换手术。三组体外循环时间、自动复跳率、血液指标、气管插管时间、入住重症监护室时间、术后住院天数差异无统计学意义。与改良St.Thomas停搏液组相比,Del Nido停搏液组、HTK停搏液组灌注次数均明显减少,主动脉阻断时间缩短,除颤率降低,差异具有统计学意义。与HTK停搏液组相比,Del Nido停搏液组治疗费用明显降低。结论 Del Nido停搏液具有与HTK停搏液同样的心肌保护效果,且治疗费用更低,易于配制,与改良 St.Thomas停搏液相比,前两者阻断时间缩短,灌注次数减少,除颤率明显降低；Del Nido停搏液在成人心脏瓣膜手术中的临床应用是安全可行的。
Abstract:ObjectiveTo compare the myocardial protective effects of three different myocardial protective fluids (Del Nido solution,HTK solution and modified St.Thomas solution) in heart valve replacement. Methods The clinical data of 120 patients undergoing valve replacement under cardiopulmonary bypass (CPB) from January 2016 to December 2018 were retrospectively analyzed.The patients were divided into three groups according to the use of myocardial protective fluid:Del Nido solution group(DN group,n=40),HTK solution group(HTK group,n=40)and modified St.Thomas solution(STH group,n=40).The following clinical data were collected:CPB time,aortic occlusion time,number of cardioplegia perfusion,automatic re-bounce rate,defibrillation rate,concentrations of troponin I (cTnI) and creatine phosphokinase isoenzyme (CK-MB) in peripheral blood 24 hours and 72 hours after operation,days of positive inotropic drug use after operation,tracheal intubation time,intensive care unit time,postoperative hospital stay,cost of cardioplegia treatment,ejection fraction after operation. Results There were no significant differences in basic clinical data such as gender,age,weight,and preoperative EF among three groups (P>0.05).All patents in three groups successfully completed valve replacement surgery.There were no significant differences in CPB time,automatic re-bounce rate,blood index,tracheal intubation time,intensive care unit time,and postoperative hospital stay among three groups(P>0.05).Compared with STH group,the number of cardioplegia perfusion and defibrillation rate decreased,aortic occlusion time shortened in DN group and HTK group.The difference was statistically significant(P<0.05).Compared with HTK group,the cost of cardioplegia treatment in DN group significantly reduced(P<0.05). Conclusion Del Nido solution has the same myocardial protective effect as HTK solution,and it has lower treatment cost and is easier to prepare.Compared with modified St.Thomas solution,Del Nido solution and HTK solution were with less cardioplegia perfusion number and defibrillation rate,as well as shorter aortic occlusion time.The clinical application of Del Nido cardioplegia in adult heart valve surgery is safe and feasible.
文章编号： 中图分类号：R 654.1 文献标志码：A
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引用文本：
刘何,焦思杨,马路遥,郑翔翔,秦建伟.三种停搏液在成人瓣膜置换术中的心肌保护效果[J].中国临床研究,2019,32(6):775-778.
刘何,焦思杨,马路遥,郑翔翔,秦建伟.三种停搏液在成人瓣膜置换术中的心肌保护效果[J].中国临床研究,2019,32(6):775-778.