4∶1含血停搏液与组氨酸-色氨酸-酮戊二酸液在心脏瓣膜置换术中的应用效果

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摘要目的探讨4∶1含血停搏液与国产组氨酸-色氨酸-酮戊二酸（HTK）液在心脏瓣膜置换术中的应用效果。方法回顾性分析2018年2月至2020年12月于清远市人民医院行体外循环下心脏瓣膜置换术的64 例患者的临床资料，根据体外循环主动脉阻断使用心肌保护液的不同将其分为H 组和G 组，每组各32 例。H 组患者采用单次灌注国产HTK 液作为心肌保护液诱导心脏停搏，G 组患者采用多次灌注4∶1含血停搏液。比较两组患者麻醉诱导后转机前（T1）、转机10 min（T2）、主动脉阻断灌注停跳液后10 min（T3）、体外循环开始复温5 min 后（T4）、主动脉开放后10 min（T5）、停机后（T6）的血气指标、电解质浓度、平均动脉压（MAP）及围手术期指标。结果两组患者不同时刻的血气pH 值比较，差异无统计学意义（P＞0.05）。H 组患者T3、T4、T5 时刻的|BE|值高于G 组，差异有统计学意义（P＜0.05）；H 组患者T3 时刻的Lac 低于G 组，T4、T5 时刻的Lac 高于G 组，差异有统计学意义（P＜0.05）；H 组患者T5 时刻的动脉血二氧化碳分压（PaCO2）高于G 组，差异有统计学意义（P＜0.05）；H 组患者T4 时刻的电解质K+浓度低于G 组，差异有统计学意义（P＜0.05）；H 组患者T3、T4 时刻的HCT 值低于G 组，差异有统计学意义（P＜0.05）；H 组患者T5 时刻的MAP 低于G 组，差异有统计学意义（P＜0.05）；H 组患者T2、T3、T4、T5、T6 时刻的Pa-CO2、HCT、MAP 值低于本组T1 时刻，T4、T5、T6 时刻的Lac 值高于本组T1 时刻，T3、T4、T5、T6 时刻的K+浓度高于本组T1 时刻，差异有统计学意义（P＜0.05）；G 组患者T2、T3、T4、T5、T6 时刻的PaCO2、HCT 值低于本组T1 时刻，T3、T4、T5、T6时刻的K+浓度高于本组T1 时刻，T2、T3、T5、T6 时刻的MAP 值低于本组T1 时刻，T4、T5、T6 时刻的Lac 值高于本组T1时刻，差异有统计学意义（P＜0.05）。两组患者的手术时间、ICU 停留时间及术后并发症发生率比较，差异无统计学意义（P＞0.05）；H 组患者的体外循环转流时间短于G 组，停搏液用量低于G 组，差异有统计学意义（P＜0.05）。结论体外循环下瓣膜置换术中使用4∶1含血停搏液与国产HTK 液相比，对患者的内环境影响较小。

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	龚建平
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	刘玉妍
	冷冰花
	陈国民
	李恒

关键词 ：心脏瓣膜病, 体外循环, 组氨酸-色氨酸-酮戊二酸, 血气分析, 平均动脉压

Abstract：Objective To investigate the application effect of 4∶1 blood cardioplegic fluid and domestic histidine -tryptophan-ketoglutaric acid(HTK)in cardiac valve replacement.Methods A retrospective analysis was performed on the clinical data of 64 patients undergoing cardiac valve replacement under extracorporeal circulation in Qingyuan People's Hospital from February 2018 to December 2020.The patients were divided into group H and group G according to the different use of myocardial protective fluid during cardiopulmonary bypass aorta occlusion,with 32 cases in each group.Patients in group H were treated with a single infusion of domestic HTK liquid as myocardial protective fluid to induce cardiac arrest,and patients in group G were treated with multiple perfusion of 4∶1 blood cardioplegia fluid.Blood gas indexes,electrolyte concentration,mean arterial pressure(MAP)and perioperative indexes before transfer after induction of anesthesia(T1),10 min after transfer(T2),10 min after aorta blocking infusion of stopper fluid(T3),5 min after cardiopulmonary bypass rewarming(T4),10 min after aortic opening at min(T5)and after shutdown(T6)were compared between the two groups of patients.Results There were no significant differences in blood gas pH value between the two groups at different time(P＞0.05).|BE| value of group H at T3,T4 and T5 moment were higher than those of the group G,the differences were statistically significant(P＜0.05).Lac in group H at T3 was lower than that in group G,Lac at T4 and T5 were higher than those in group G,the differences were statistically significant(P＜0.05).Carbon dioxide partial pressure(PaCO2)at T5 in group H was higher than that in group G,the difference was statistically significant(P＜0.05).Electrolyte K+concentration at T4 in group H was lower than that in group G,the difference was statistically significant(P＜0.05).The HCT value of group H at T3 and T4 were lower than those of group G,and the differences were statistically significant(P＜0.05).The MAP of group H at T5 was lower than that of group G,the difference was statistically significant(P＜0.05).In group H,PaCO2,HCT and MAP values at T2,T3,T4,T5 and T6 were lower than those at T1,Lac values at T4,T5 and T6 were higher than those at T1,and K+ concentrations at T3,T4,T5 and T6 were higher than those at T1,the differences were statistically significant(P＜0.05).PaCO2 and HCT values of patients at T2,T3,T4,T5 and T6 in group G were lower than T1,K+concentration at T3,T4,T5 and T6 were higher than T1,MAP value at T2,T3,T5 and T6 were lower than T1,Lac value at T4,T5 and T6 were higher than T1,the differences were statistically significant(P＜0.05).There were no significant differences in operation time,ICU stay time and incidence of postoperative complications between the two groups(P＞0.05).The time of cardiopulmonary bypass in group H was shorter than that in group G,and the amount of cardiopulmonary bypass was lower than that in group G,the differences were statistically significant(P＜0.05).Conclusion The use of 4∶1 blood containing cardiopulmonary bypass solution and home-made HTK fluid during valve replacement with cardiopulmonary bypass has less influence on the internal environment of patients.

Key words： Cardiac valvular disease；Cardiopulmonary bypass Histidine-tryptophan-copper glutarate Blood gas analysis Mean arterial pressure

基金资助:广东省清远市科学技术局自筹经费项目（2018B 016）

作者简介: 龚建平（1979-），男，江西樟树人，硕士，副主任医师，主要研究方向：心血管麻醉及体外循环

引用本文:

龚建平;梁秀生;李伟超;刘玉妍;冷冰花;陈国民;李恒. 4∶1含血停搏液与组氨酸-色氨酸-酮戊二酸液在心脏瓣膜置换术中的应用效果[J]. 中国当代医药, 2022, 29(10): 14-19.
GONG Jianping ;LIANG Xiusheng; LI Weichao ;LIU Yuyan; LENG Binghua ;CHEN Guomin ;LI Heng. Application effect of 4∶1 blood cardioplegia and histidine-tryptophan-ketoglutarate solution in cardiac valve replacement. 中国当代医药, 2022, 29(10): 14-19.

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[1]	丁凡，王新宽，尤涛，等.体外循环下心血管手术与肾素-血管紧张素系统的关系[J].国际心血管病杂志，2011，38（5）：290-292.
[2]	李莎，王波，刘彬，等.心脏直视手术后早期心肌顿抑的诊断与治疗[J].中国胸心血管外科临床杂志，2019，26（3）：294-296.
[3]	庄心良，曾因明，陈伯銮.现代麻醉学[M].3 版.北京：人民卫生出版社，2003：792-793.
[4]	Jynge P，Hearse DJ，Feuvray D，et al.The St.Thomas' hospital cardioplegic solution:a characterization in two species[J].Scand J Thorac Cardiovasc Surg Suppl，1981，30：1-28.
[6]	Bretschneider HJ.Myocardial protection[J].Thorac Cardiovasc Surg，1980，28：295-302.
[9]	宫美慧，李咏梅，蒋树林，等.HTK 液与冷血停搏液在心脏瓣膜手术中应用对比：倾向得分匹配分析[J].现代生物医学进展，2020，20（16）：3057-3061.
[10]	辛梅，赵凯，倪尔连，等．HTK 液与含血停搏液用于瓣膜置换联合房颤射频消融治疗患者术中心肌保护的研究[J].中国体外循环杂志，2013，11（4）：207-212.
[11]	汪洋，葛圣林，高晴云，等.成人心脏瓣膜病体外循环术中灌注流量选择[J].实用医学杂志，2017，33（22）：3792-3794.
[5]	Karthik S，Grayson AD，Oo AY，et al.A survey of current myocar-dial protection practices during coronary artery bypass grafting[J].Ann R Coll Surg Engl，2004，86（6）：413-415.
[7]	Feirer N，Dieterlen MT，Klaeske K，et al.Impact of Custodiol-N cardioplegia on acute kidney injury after cardiopulmonary bypass[J].Clin Exp Pharmacol Physiol，2020，47（4）：640-649.
[8]	Teloh JK，Daniel-Sebastian D，Miriam P，et al.Histidine and other amino acids in blood and urine after administration of Bretschneider solution（HTK）for cardioplegic arrest inpatients：effects on N-Metabolism[J].Amino Acids，2016，48（6）：1-10.
[12]	Demen P，Elkouti S，Martineau R，et al.Outcome with high blood lactate levels during cardiopulmonary bypass in adult cardiac surgery[J].Ann Thorac Surg，2000，70（6）：2082-2086.
[13]	李莹，刘威，黄惠斌，等.体外循环术后谵妄患者血气指标分析[J].福建医药杂志，2015，37（3）：72-73.
[14]	Curley G，Kavanagh BP，Laffey JG，et al.Hypocapnia and the in-jured brain：more harm than benefit[J].Crit Care Med，2010，38（5）：1348-1359.
[15]	马利，黄中华.急性高容量血液稀释对脑氧代谢的影响[J].中国实用医药，2008，3（28）：9-11.
[16]	张汝，严中亚.血气分析在体外循环手术围术期的应用及其意义[J].中国临床保健杂志，2012，15（3）：259-261.
[17]	Lin YZ，Huang JB，Li XW，et al.Clinical comparative analysis of histidine-tryptophan-ketoglutarate solution and St.Thomas crystalloid cardioplegia：A 12-year study from a single institution[J].Exp Ther Med，2017，14（3）：2677-2682.
[18]	Braathen B，Jeppsson A，Scherstén H，et al.One single dose of histidine-tryptophan-ketoglutarate solution givesequally good myocardial protection in elective mitral valve surgery as re-petitive cold blood cardioplegia：a prospective randomized study[J].J Thorac Cardiovasc Surg，2011，141（4）：995-1001.
[19]	Viana FF，Shi WY，Hayward PA，et al.Custodiol versus blood cardioplegia in complex cardiac operations：an Australian experience[J].Eur J Cardiothorac Surg，2013，43（3）：526-531.