HTK液在大血管转位手术中的应用研究

目的探讨Switch手术中心肌保护的整体策略。方法回顾分析30例应用HTK液为心肌保护液,行大血管转位术(Arterial Switch Operation,Switch术)的病例。术中心肌保护液灌注,术后24小时内采血检测血清肌钙蛋白I(cardiac troponin I,cTnI),脑利钠肽(Brain Natriuretic Peptide,BNP)含量的变化。记录心脏自动复跳率,术后惊厥发生率,术后插管时间及监护室时间等指标,分析心肌保护效果及内环境变化检测。结果所有病例均于主动脉根部灌注1次,平均主动脉阻断时间91.33±24.90min,HTK心肌保护液平均用量51.73ml/Kg,停跳效果好,术中无需再行冠状动脉内灌注,自动复跳率100%,术毕Na+浓度处于正常范围,术后无惊厥发生,监护室恢复顺利。结论 HTK心肌保护液适用于未成熟心肌,心肌保护时间长、避免冠状动脉内灌注的特点更适用于Switch手术。

The Strategy of Immature Myocardium Protection in Arterial Switch Operation

Objective To Investigate the integrated myocardium protection in Switch operation. Method From 2011.6 ～ 2011.12, 30 continuous patients were performed Switch operation, during which HTK solution was used as the cardioplegia. The delivery method, the effects of myocardium protection and the change of internal environment were analyzed. Blood sample was measured for detecting the serum cTnTi and BNP at 24 hours after surgery. The spontaneous normal rhythm recovery rate, post -operative seizure rate, and the ICU information were recorded. Result All the patiendts were delivered cardioplegia only once, and the average aortic clamping time was 91.33 ± 24.90min, average dose of HTK solution was 51.73ml/Kg. The effects of myocardium protection were satisfactory, no patient needed more intra - coronary infusion, and the spontaneous normal rhythm recovery rate was 100%. Post- operative sodium concentration was normal, no seizure occurred, and the recovery in the ICU was smooth. Conclusion HTK solution is suitable for immature myocardium protection. The characters of long protection time and avoiding intra -coronary infusion are useful for Switch operation.