David I术中顺行性与逆行性灌注del Nido心脏停搏液的心脏保护作用研究

目的：逆行性灌注del Nido心脏保护液的保护作用仍存在争议。我们假设在David I术中顺行性灌注与逆行性灌注del Nido心脏保护液有相同的保护作用。方法：回顾性分析我科于2014年6月至2018年1月行David I 手术的110例患者，患者早期行David I手术均为顺行性灌注组（2014年6月-2016年5月），后期为逆行性灌注组（2016年5月-2018年1月），比较两组临床后果，随访6至36月。结果：两组中均无临床死亡及再手术。体外循环时间、主动脉阻断时间比较无差异。两组中肌钙蛋白I水平，心肌酶谱，左室射血分数，呼吸机辅助时间，监护室时间及住院日期均相似。顺行性灌注组中乳酸水平高于逆行性灌注组(9.33±2.18 vs 7.22±1.44, P=0.018)。传导阻滞发生率在逆行性灌注组中（6例）高于顺行性灌注组（10.17% vs 1.96%, P=0.009)，但仅有1名患者（1.69%）需要永久起搏器置入。结论：在David I 手术中，顺行性和逆行性灌注del Nido心脏停搏液都是安全有效的。持续逆行性灌注del Nido心脏停搏液往往伴随着可接受的传导阻滞发生率及较低的乳酸水平。

Antegrade versus retrograde del Nido cardioplegia in David I procedure

Object:The efficacy of continuous retrograde del Nidocardioplegia for myocardial protection in David operation is still controversial.We hypothesized that the antegrade and retrograde cardioplegia offer equivalent safety for myocardial protection.Methods:We retrospectively reviewed 110 patients undergoing David I operation with antegrade or retrograde del Nido solution from June 2014 to January 2018. The patients received David I operation in early stage were entered into the antegrade group(June 2014- May 2016), and later were in the retrograde group(May 2016-January 2018). The outcomes were compared.The follow-up was 6 month to 36 months.Results:There was no hospital mortality or reoperation in both groups.Cardiopulmonary bypass, aortic clamp times are similar. Troponin I level, CKMB, Left ventricle ejection fraction, ventilation times, intensive care unit and hospital stay times are similar between 2 groups.The lactate level is slightly higher((9.33±2.18 vs 7.22±1.44, P=0.018) in antegrade group compared with retrograde group. The incidence rate of heart block is higher(6 patients) in retrograde group(10.17% vs 1.96%, P=0.009).Only 1 patient(1.69%) is required implantation of permanent cardiac pacemaker.Conclusion: The antegrade and continuous retrograde del Nidocardioplegia can be used safely and effectively in David I operation. The continuous retrograde del Nido cardioplegia is associated with acceptable morbidity of heart block and lower lactate level.