康斯特保护液对紫绀型先天性心脏病未成熟心肌保护效果的临床研究

目的探讨康斯特保护液（HTK液）对紫绀型未成熟心肌保护效果。方法将40例体重在8kg～15kg，血氧饱和度低于80％紫绀型先天性心脏病患儿（其中包括法洛四联症，单心室，右室双出口患者），随机分成两组，分别用ST．Thomas Ⅱ液（A组）、HTK液（B组）灌注心脏。于麻醉诱导后、升主动脉开放后3min分别采血检测血清肌钙蛋白Ⅰ（cardiac troponin Ⅰ，cTnI）、肌酸磷酸激酶同工酶（creativekinaseMB，CKMB）及乳酸脱氢酶（lactatedehy drogenase，LDH）含量的变化；记录心脏自动复跳率、心律失常发生率、术后正性肌力药物用量、呼吸机支持时间和ICU治疗时问等临床指标；于术前和手术结束后分别行心脏彩超检测，纪录左室的射血分数；电镜观察心肌细胞超微结构。结果主动脉开放后B组血清cTnI、CKMB含量均显著低于A组（P〈0．01）；B组自动复跳率、术后正性肌力药物用量、呼吸机支持时间和ICU治疗时间等临床指标均显著优于A组（P〈0．05）；术后当天彩超提示左室射血分数B组要优于A组（P〈0．05）；B组心肌细胞超微结构的变化显著优于A组（P〈0．05）。结论HTK停搏液在紫绀型先心病患儿手术中具有较好的心肌保护作用。

Myocardial Protection Effects of HTK Solution on Immature Myocardium of Infants with Cyanosed Congenital Heart Disease

OBJECTIVE To study the protective effects of HTK solution on immature myocardium in cardiac operation. METHODS 40 infants weighted 8 - 15 kg with cyanotic congenital heart disease and low saturation of blood oxygen （ 〈80% ） wererandomly divided into ST. Thomas Ⅱ solution group （group A） and HTK （group B）. The diagnosis of patients included tetralogy of Fallot （TOF）, double outlet right ventricle （DORV）, and single ventricle. Blood sample were collected from coronary sinus after anesthesia induction and 3 min after aorta clamp off to measure the serum level of cadiac troponin Ⅰ （cTnI）, creative kinase MB （CKMB）, and lactate dehydrogenase （LDH）. Clinical parameters including the auto- resuscitation ratio, inotropic support requirement, mechanical ventilation duration, and the stay time in the intensive care unit were recored. Ejection fraction （EF） was measured preperatively. Myocardial tissue was taken from the atrium to perform electronic microscopic examination. RESULTS The level of CKMB, LDH and cTnI in group B were lower than that in group A. The clinical parameters, the EF, and the results of electronic microscope showed that the myocardial damage in group B were less than that in group A. CONCLUSION The protective effects of HTK solution on immature myocardial in infants with cyanotic congenital heart disease is obviously better than St. Thomas solution.