中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2015年
4期
1-4,5
,共5页
HTK液%心肌保护%体外循环%重症心脏瓣膜病%心内直视手术
HTK液%心肌保護%體外循環%重癥心髒瓣膜病%心內直視手術
HTK액%심기보호%체외순배%중증심장판막병%심내직시수술
HTK solution%Myocardial protection%Cardiopulmonary bypass%Severe cardiac valve disease%Open heart operation
目的:观察HTK液在重症心脏瓣膜病患者心内直视手术中的心肌保护效果。方法:2012年4月-2013年3月,本科在16例重症心脏瓣膜病患者心内直视手术中应用HTK液灌注心脏进行心肌保护,通过与同时期应用冷血停搏液灌注的16例患者的临床指标进行对比分析,评价其心肌保护效果。结果:HTK液组心脏自动复跳率高于冷血停搏液组(P<0.05);HTK液组手术时间、体外循环时间、主动脉阻断时间、主动脉开放至心脏复跳时间、后并行循环时间、术后呼吸机辅助时间和ICU停留时间均短于冷血停搏液组(P<0.05);HTK液组体外循环停止时多巴胺用量(5±2.5)μg/(kg·min),低于冷血停搏液组(P<0.05);HTK液组术后并发症发生率低于冷血停搏液组(P<0.05);体外循环后心肌肌钙蛋白(cTnI)、肌酸磷酸激酶同工酶(CKMB)开始升高,并于术后第1天达最高峰,但HTK液组麻醉诱导之后各时间点的cTnI、CKMB水平均低于冷血停搏液组(P≤0.05)。结论:在重症心脏瓣膜病患者心内直视手术中应用HTK液灌注心脏,心肌保护效果优于冷血停搏液。
目的:觀察HTK液在重癥心髒瓣膜病患者心內直視手術中的心肌保護效果。方法:2012年4月-2013年3月,本科在16例重癥心髒瓣膜病患者心內直視手術中應用HTK液灌註心髒進行心肌保護,通過與同時期應用冷血停搏液灌註的16例患者的臨床指標進行對比分析,評價其心肌保護效果。結果:HTK液組心髒自動複跳率高于冷血停搏液組(P<0.05);HTK液組手術時間、體外循環時間、主動脈阻斷時間、主動脈開放至心髒複跳時間、後併行循環時間、術後呼吸機輔助時間和ICU停留時間均短于冷血停搏液組(P<0.05);HTK液組體外循環停止時多巴胺用量(5±2.5)μg/(kg·min),低于冷血停搏液組(P<0.05);HTK液組術後併髮癥髮生率低于冷血停搏液組(P<0.05);體外循環後心肌肌鈣蛋白(cTnI)、肌痠燐痠激酶同工酶(CKMB)開始升高,併于術後第1天達最高峰,但HTK液組痳醉誘導之後各時間點的cTnI、CKMB水平均低于冷血停搏液組(P≤0.05)。結論:在重癥心髒瓣膜病患者心內直視手術中應用HTK液灌註心髒,心肌保護效果優于冷血停搏液。
목적:관찰HTK액재중증심장판막병환자심내직시수술중적심기보호효과。방법:2012년4월-2013년3월,본과재16례중증심장판막병환자심내직시수술중응용HTK액관주심장진행심기보호,통과여동시기응용랭혈정박액관주적16례환자적림상지표진행대비분석,평개기심기보호효과。결과:HTK액조심장자동복도솔고우랭혈정박액조(P<0.05);HTK액조수술시간、체외순배시간、주동맥조단시간、주동맥개방지심장복도시간、후병행순배시간、술후호흡궤보조시간화ICU정류시간균단우랭혈정박액조(P<0.05);HTK액조체외순배정지시다파알용량(5±2.5)μg/(kg·min),저우랭혈정박액조(P<0.05);HTK액조술후병발증발생솔저우랭혈정박액조(P<0.05);체외순배후심기기개단백(cTnI)、기산린산격매동공매(CKMB)개시승고,병우술후제1천체최고봉,단HTK액조마취유도지후각시간점적cTnI、CKMB수평균저우랭혈정박액조(P≤0.05)。결론:재중증심장판막병환자심내직시수술중응용HTK액관주심장,심기보호효과우우랭혈정박액。
Objective:To observe the myocardial protective effect of the HTK solution in open heart operation for severe cardiac valve disease patients.Method:16 severe cardiac valve disease patients undergone open heart operation were received HTK solution for myocardial protection from April 2012 to March 2013,and their clinical data was compared with that of another 16 severe cardiac valve disease patients received cold blood cardioplegia for myocardial protection. Result:The ratio of spontaneous cardiac rhythm recovery in the HTK solution group was higher than that of cold blood cardioplegia group(P<0.05).The average operation time,the cardiopulmonary bypass time,the aortic clamping time,the time from aorta declaming to heart rebeating,the assisted circulation time after aorta declaming,the mechanical ventilation support time,and the length-of-stay in ICU after operation in the HTK solution group were shorter than those of cold blood cardioplegia group(P<0.05).The dose of dopamine at the end of cardiopulmonary bypass was(5±2.5)μg/(kg·min), was less than that of cold blood cardioplegia group(P<0.05).The ratio of postoperative severe complications in the HTK solution group was also lower than that of cold blood cardioplegia group(P<0.05).The concentration of cTnI and CKMB was elevated after the onset of cardiopulmonary bypass,and the peak of cTnI and CKMB on the first postoperative day in two groups.The HTK solution group had lower cTnI and CKMB concentrations compared with cold blood cardioplegia group after cardiopulmonary bypass(P ≤ 0.05).Conclusion:The myocardial protective effect of the HTK solution in open heart operation for severe cardiac valve disease patients is better than that of cold blood cardioplegia.