中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

Del Nido 心肌保护液在成人心脏瓣膜手术中应用的病例对照研究

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目的 探讨 Del Nido 心肌保护液在成人心脏手术中心肌保护效果,分析其在成人心脏直视术中相关优势。 方法 回顾性分析 2016 年 6 月至 2017 年 1 月我院成人心脏瓣膜术中应用 Del Nido 心肌保护液 96 例患者的临床资料,其中男 44 例、女 52 例,平均年龄(51.36±13.31)岁,作为 Del Nido 心肌保护液组(DNC 组)。选取同期应用传统心肌保护液 96 例患者作为传统心肌保护液组(CTC 组),其中男 53 例、女 43 例,平均年龄(52.91±10.95)岁。记录主动脉阻断时间、体外循环时间、心肌保护液灌注次数及总量、自动复跳率、围术期输血量及术后 24 h 内正性肌力药使用情况等。 结果 DNC 组和 CTC 组患者年龄、体质量、射血分数、红细胞压积、体外循环时间、主动脉阻断时间差异无统计学意义(P>0.05)。两组自动复跳率、术后 24 h 正性肌力药物评分、心肌酶学、肌钙蛋白-I 及住 ICU 时间差异无统计学意义(P>0.05)。与 CTC 组相比,DNC 组术中心肌保护液灌注总量、灌注次数、围术期输血量均较少,差异具有统计学意义(P<0.05)。两组术后均无新发心房颤动及院内死亡。 结论 Del Nido 心肌保护液在成人心脏瓣膜手术中有良好的心肌保护作用,同时可减少静态预充量,降低血液稀释及围术期输血量。

Objective To investigate the myocardial protective effects of Del Nido cardioplegia and analyze its advantages in adult cardiac surgery. Methods We retrospectively analyzed the clinical data of 96 adult patients undergoing cardiac valve surgery who received Del Nido cardioplegia (a DNC group) from June 2016 to January 2017 in our hospital. There were 44 males and 52 females with a mean age of 51.36±13.31 years. Meanwhile 96 patients who received conventional cardioplegia were recruited as a control group (a CTC group) and there were 53 males and 43 females with a mean age of 52.91±10.95 years. Cross-clamping time, cardiopulmonary bypass (CPB) time, total volume of and transfusion frequency of cardioplegia, the rate of spontaneous defibrillation, red blood cell transfusion and vasoactive-inotropic score at postoperative 24 hours (VIS 24) were recorded. Results No significant difference was found in age, body weight, ejection fraction, hematokrit, CPB time and cross-clamping time between the DNC group and CTC group. There was no significant difference in the rate of spontaneous defibrillation, VIS 24, cardiac enzymes and cardiactroponin I and length of ICU stay between the two groups. The total volume and transfusion frequency of cardioplegia, perioperative blood transfusion were lower in the DNC group. There was no new atrial fibrillation or in-hospital death in the two groups. Conclusion Del Nido is a good myocardial protection solution in adult cardiac valve surgery, and requires less static preload volume and reduceshemodilution and perioperative blood transfusion.

关键词: 心肌保护; Del Nido 心肌保护液; 成人心脏瓣膜术

Key words: Myocardial protection; Del Nido cardioplegia; adult valve surgery

引用本文: 吕晓钗, 叶建熙, 刘燕. Del Nido 心肌保护液在成人心脏瓣膜手术中应用的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(9): 781-785. doi: 10.7507/1007-4848.201710036 复制

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1. Valooran GJ, Nair SK, Chandrasekharan K, et al. Del Nido cardioplegia in adult cardiac surgery-scopes and concerns. Perfusion, 2016, 31(1): 6-14.
2. 易定华, 徐志云, 王辉山, 主编. 心脏外科学. 第 2 版. 北京: 人民军医出版社, 2016. 428-576.
3. Matte GS, del Nido PJ. History and use of del Nido cardioplegia solution at Boston Children’s Hospital. J Extra Corpor Technol, 2012, 44(3): 98-103.
4. Gaies MG, Gurney JG, Yen AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med, 2010, 11(2): 234-238.
5. Rizoli S. PlasmaLyte. J Trauma, 2011, 70(5 Suppl): S17-S18.
6. Lessen R, DiCapua J, Pekmezaris R, et al. Our experience with two cardioplegic solutions: dextrose versus nondextrose in adult cardiac surgery. J Extra Corpor Technol, 2012, 44(3): 134-138.
7. Gandhi GY, Nuttall GA, Abel MD, et al. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc, 2005, 80(7): 862-866.
8. Bito A, Inoue K, Asano M, et al. Experimental myocardial preservation study of adding perfluorochemicals (FC43) in lidocaine cardioplegia. Jpn J Thorac Cardiovasc Surg, 2000, 48(5): 280-290.
9. Brown PS, Holland Fw, Parenteau GL, et al. Magnesium ion is beneficial in hypothermic crystalloid cardioplegia. Ann Thorac Surg, 1991, 51(3): 359-367.
10. Powell WJ Jr, DiBona DR, Flores J. The protective effect of hyperosmotic mannitol in myocardial ischemia and necrosis. Circulation, 1976, 54(4): 603-615.
11. Goodwin GW, Ahmad F, Doenst T, et al. Energy provision from glycogen, glucose and fatty acids on adrenergic stimulation of isolated working rat hearts. Am J Physiol, 1998, 274(4 Pt 2): H1239-H1247.
12. Lopaschuk GD, Wambolt RB, Barr RL. An imbalance between glycolysis and glucose oxidation is a possible explanation for the detrimental effects of high levels of fatty acids during aerobic reperfus-ion of ischemic hearts. J Pharmacol Exp Ther, 1993, 264(1): 135-144.
13. Mick SL, Robich MP, Houghtaling PL, et al. Del Nido versus Buckberg cardioplegia in adult isolated valve surgery. J Thorac Cardiovasc Surg, 2015, 149(2): 626-634.
14. Ramanathan R, Parrish DW, Armour TK, et al. Use of del Nido cardioplegia in adult cardiac surgery. Thorac Cardiovasc Surg, 2015, 63(7): 624-627.
15. Sorabella RA, Akashi H, Yerebakan H, et al. Myocardial protection using Del Nido cardioplegia solution in adult reoperative aortic valve surgery. J Card Surg, 2014, 29(4): 445-449.
16. Grosso MA, Banerjee A, St Cyr JA, et al. Cardiac 5’-nucleotidase activity increases with age and inversely relates to recovery from ischemia. J Thorac Cardiovasc Surg, 1992, 103(2): 206-209.
17. Yerebakan H, Sorabella RA, Najjar M, et al. Del Nido cardioplegia can be safely administered in high risk coronary artery bypass grafting surgery after acute myocardial infarction: a propensity matched comparison. J Cardiothorac Surg, 2014, 9: 141.
18. Vistarini N, Laliberté E, Beauchamp P, et al. Del Nido cardioplegia in the setting of minimally invasive aortic valve surgery. J Perfusion, 2017, 32(2): 112-117.