CAJ | 학술논문

目的：观察在冠状动脉旁路移植术（ CABG）体外循环（ ECC）中，使用心肌保护麻痹溶液（ HTK液）进行心肌保护时，患者血浆渗透压及血钠浓度的变化规律。方法选择2013年01月至2013年3月68例在本科行ECC下CABG的患者，其中男55例，女13例，年龄39～81岁，体重50～99 kg。常规采用浅低温ECC，滚压泵单次灌注4℃ HTK液1500～3000 ml行心肌保护。分别于ECC前（ T1）、ECC开始后（ T2）、HTK液灌注结束后（ T3）、ECC 30 min时（ T4）、停机前（ T5）、拔除主动脉插管后（ T6）及出手术室前（ T7）抽取动脉血检测血Na＋浓度及血浆渗透压。记录术后呼吸机辅助时间、ICU停留时间、术中及术后24 h内输血量、术后24 h内心包纵隔引流量、术后神经系统并发症等术后一般情况。结果全部患者无死亡，均痊愈出院，未见神经系统并发症发生。血Na＋浓度T1与T2相比无明显差异（ P＞0．05），HTK液灌注结束后（ T3）显著降低（与T1、T2相比P＜0．001），之后在T4、T5及T6时间点逐渐回升，至T7时间点基本回升至基础水平；血浆渗透压的变化情况与血Na＋浓度变化基本类似，T1与T2相比无明显差异（ P＞0．05），HTK液灌注结束后（ T3）显著降低（与T1、T2相比P＜0．001），之后在T4、T5及T6时间点逐渐回升，至T7时间点基本回升至基础水平。结论 HTK液作为心脏停搏液用于CABG中具有良好的心肌保护效果，但同时也会导致血Na＋浓度及血浆渗透压显著降低，应给予足够重视并积极处理。
목적：관찰재관상동맥방로이식술（ CABG）체외순배（ ECC）중，사용심기보호마비용액（ HTK액）진행심기보호시，환자혈장삼투압급혈납농도적변화규률。방법선택2013년01월지2013년3월68례재본과행ECC하CABG적환자，기중남55례，녀13례，년령39～81세，체중50～99 kg。상규채용천저온ECC，곤압빙단차관주4℃ HTK액1500～3000 ml행심기보호。분별우ECC전（ T1）、ECC개시후（ T2）、HTK액관주결속후（ T3）、ECC 30 min시（ T4）、정궤전（ T5）、발제주동맥삽관후（ T6）급출수술실전（ T7）추취동맥혈검측혈Na＋농도급혈장삼투압。기록술후호흡궤보조시간、ICU정류시간、술중급술후24 h내수혈량、술후24 h내심포종격인류량、술후신경계통병발증등술후일반정황。결과전부환자무사망，균전유출원，미견신경계통병발증발생。혈Na＋농도T1여T2상비무명현차이（ P＞0．05），HTK액관주결속후（ T3）현저강저（여T1、T2상비P＜0．001），지후재T4、T5급T6시간점축점회승，지T7시간점기본회승지기출수평；혈장삼투압적변화정황여혈Na＋농도변화기본유사，T1여T2상비무명현차이（ P＞0．05），HTK액관주결속후（ T3）현저강저（여T1、T2상비P＜0．001），지후재T4、T5급T6시간점축점회승，지T7시간점기본회승지기출수평。결론 HTK액작위심장정박액용우CABG중구유량호적심기보호효과，단동시야회도치혈Na＋농도급혈장삼투압현저강저，응급여족구중시병적겁처리。
Objective To observe the influence of histidine-tryptophane-ketoglutarate ( HTK) cardioplegia solution on the plasma osmotic pressure of patients underwent coronary artery bypass grafting with extracorporeal circulation ( ECC) . Methods From January 2013 to March 2013, total 68 patients ( 55 males and 13 females) underwent coronary artery bypass grafting with ECC in our department. The age of these patients was 39-81 years old, and body weight was 50-99 kg. Routinely mild hypothermia ECC was ap-plied. 1500-3000 mL 4℃ HTK solution was perfused by the pump for myocardial preservation. The arterial blood samples of all pa-tients were taken to measure the concentration of serum sodium and the plasma osmotic pressure at these time points: before ECC ( T1) , before administration of HTK solution ( T2) , after administration of HTK solution ( T3) , 30 min after ECC beginning ( T4) , ECC ending ( T5) , aortic cannula removing ( T6) and patient leaving operating room ( T7) . Results A total of 68 patients were in-cluded in the study. All patients were normo-natremic at start of surgery. All patients developed hyponatremia after administration of HTK solution with a significant drop of serum sodium of 15 mmol/L ( P<0.01) . Meanwhile, the plasma osmotic pressure dropped sig-nificantly after administration of HTK solution ( P<0.01) . Both the serum sodium and the plasma osmotic pressure didn't reverse to the basic level ( T1) until patients leaved operating room ( T7) . Conclusion Both acute hyponatremia and low plasma osmotic pressure could occur during cardioplegia perfusion with HTK solution in coronary artery bypass grafting with ECC, and different strategy of ECC should be applied in this situation.