大血管手术中康斯特保护液与含血停搏液心肌保护效果比较

目的回顾性分析大血管手术中采用康斯特保护液(HTK液)与含血停搏液的心肌保护效果,为临床合理使用心脏停搏液提供依据。方法回顾性分析2003年4月至2006年12月100例采用多次灌注含血停搏液的大血管手术患者作为含血停搏液组(BC组),2014年1月至2014年7月100例使用单次灌注HTK液的大血管手术患者作为HTK液组(HTK组)。采用倾向评分匹配方法在上述资料中选择合适病例进行匹配,消除体外循环时间上的差异。共获得BC组43例与HTK组43例配对。结果 BC组平均阻断时间为(102±40)min;HTK组阻断时间为(103±31)min(P=0.87)。主动脉开放后两组心脏自动复跳率没有差别。血心肌型肌酸激酶同功酶在手术当天显著增高,术后第1 d、2 d逐渐回落,统计显示两组之间没有差异。术后两组血管活性药物的使用也无差异。两组患者均无死亡。结论 HTK液在大血管手术中的心肌保护效果同含血停搏液多次灌注一致。单次灌注HTK液具有简化外科操作的临床优越性。

Comparison between HTK solution and blood cardioplegia in the aortic surgery

Objective To compare myocardial protective effects between HTK solution and blood cardioplegia in the aortic surgery. Methods One hundred cases of aortic surgery accepted multiple-dose blood cardiaplegia from 2003 April to 2006 December were divided into blood cardioplegia group （ BC group） , and other 100 cases with single-dose of HTK solution from 2014 January to 2014 July into HTK solution group （ HTK group） . The appropriate cases were selected in those cases to eliminate the difference of bypass time with propensity-score matching method. A total of 43 cases in BC group and 43 cases in HTK group were matched. Results Average aortic cross-clamping time was 102±40 min in BC group and 103±31 min in HTK group （ P =0.87）. The rate of heart beating spontaneously after cross-clamping released was similar between two groups. Serum CKMB levels increased significantly in two groups at operative day and then decreased gradually in postoperative 2 days, there was no significant difference between two groups. The vasoactive drugs also had no difference between two groups. No death occurred in two groups. Conclusion Myocardial protective effect of single-dose HTK solution in aortic surgery is similar to that of multiple-dose of blood cardioplegia. A single-dose of HTK solution is benefit for simplifying the aortic surgical procedures.