CAJ | 학술논문

目的比较HTK液和含血停搏液在风湿性心脏病患者瓣膜置换术中的心肌保护效果.方法 42例风湿性心脏病联合瓣膜病的患者分为对照组(应用4∶1冷含血停搏液)和实验组(应用HTK液).测定麻醉诱导前、术后6、12、24 h的心排量(CO)和心脏指数(CI),并比较两组患者主动脉阻断时间、主动脉开放到心脏复跳时间、辅助循环时间、心脏自动复跳率、心律失常、起搏器应用、多巴胺平均最大剂量、呼吸机支持时间等临床指标.结果实验组患者术后12 h和24 h监测点心排量和心指数均高于对照组[12 h:(4.82±0.18)L/min vs(3.50±0.32) L/min,(3.80±0.48)L/(min· m2) vs (2.79±0.39)L/(min· m2);24 h:(4.97±0.45) L/min vs( 3.81±0.19) L/min,(4.22±0.17)L/(min·m2) vs (2.91±0.21)L/(min·m2),P＜0.05]；主动脉阻断时间、主动脉开放到心脏复跳时间、辅助循环时间,多巴胺最大剂量、呼吸机支持时间均低于对照组[(53.6±24.3)min vs(68.9±26.1)min;(1.8±1.3)min vs (2.3±1.2)min; (33±11)min vs (42±13)min; (10.2±2.1)μg/(kg·min) vs (15.7±3.8) μg/( kg·min);( 14.6±4.8)h vs (20.7±5.1)h,P＜0.05],心脏自动复跳率高于对照组(90％ vs 67％,P＜0.05),术后出现心律失常、低心排和使用临时心脏起搏器的患者数在实验组中明显减少.结论 HTK心脏停搏液对风湿性心脏病患者瓣膜置换术中心肌的保护作用优于1∶4含血停搏液.
목적 비교HTK액화함혈정박액재풍습성심장병환자판막치환술중적심기보호효과.방법 42례풍습성심장병연합판막병적환자분위대조조(응용4∶1랭함혈정박액)화실험조(응용HTK액).측정마취유도전、술후6、12、24 h적심배량(CO)화심장지수(CI),병비교량조환자주동맥조단시간、주동맥개방도심장복도시간、보조순배시간、심장자동복도솔、심률실상、기박기응용、다파알평균최대제량、호흡궤지지시간등림상지표.결과 실험조환자술후12 h화24 h감측점심배량화심지수균고우대조조[12 h:(4.82±0.18)L/min vs(3.50±0.32) L/min,(3.80±0.48)L/(min· m2) vs (2.79±0.39)L/(min· m2);24 h:(4.97±0.45) L/min vs( 3.81±0.19) L/min,(4.22±0.17)L/(min·m2) vs (2.91±0.21)L/(min·m2),P＜0.05]；주동맥조단시간、주동맥개방도심장복도시간、보조순배시간,다파알최대제량、호흡궤지지시간균저우대조조[(53.6±24.3)min vs(68.9±26.1)min;(1.8±1.3)min vs (2.3±1.2)min; (33±11)min vs (42±13)min; (10.2±2.1)μg/(kg·min) vs (15.7±3.8) μg/( kg·min);( 14.6±4.8)h vs (20.7±5.1)h,P＜0.05],심장자동복도솔고우대조조(90％ vs 67％,P＜0.05),술후출현심률실상、저심배화사용림시심장기박기적환자수재실험조중명현감소.결론 HTK심장정박액대풍습성심장병환자판막치환술중심기적보호작용우우1∶4함혈정박액.
Objective To evaluate the effect of HTK solution on myocardial protection during valve replacement surgery.Methods 42 patients with rheumatic heart disease were randomized to receive 4∶1cold blood (control group,n =21 ) and HTK ( protective gronp,n =21 ) cardioplegic solution during valve replacement.The changes of CO and CI were collected at different time points including pre-operation,postoperative 6 hours,12 hours and 24 hours.Aortic clamping time,the ratio of spontaneous cardiac rhythm recovery and inotropic drugs application were calculated,and mechanical ventilation support time and the incidence of arrhythmia were recorded.Results The measurements of CO and CI showed that there was significant higher level in protective group at postoperative 12 hours and 24 hours [ 12 h:(4.82 ± 0.18 ) L/min vs ( 3.50 ± 0.32 ) L/min,( 3.80 ± 0.48 ) L/( min · m2 ) vs (2.79 ± 0.39) L/( min · m2 ) ;24 h:(4.97±0.45)L/min vs ( 3.81 ±0.19)L/min,(4.22±0.17)L/(min · m2) vs (2.91 ±0.21)L/(min·m2 ),P ＜ 0.05].The clinical parameters including aortic clamping time,incidence of cardiac arrhythmia,inotropic support,duration of mechanical ventilation and length was lower than in control group [ (53.6 ±24.3 ) min vs ( 68.9 ± 26.1 ) min ; ( 1.8 ± 1.3 ) min vs ( 2.3 ± 1.2 ) min ; ( 33 ± 11 ) min vs ( 42 ± 13 ) min ;(10.2±2.1) μg/(kg · min) vs (15.7 ±3.8) μg/(kg · min);(14.6 ±4.8)h vs (20.7 ±5.1)h,P ＜0.05].The auto-beating rate was higher than in control group (90％ vs 67％,P ＜0.05).Conclusions HTK solution is better than classical blood cardioplegia in myocardial protection during valve replacement.