作者：赵雪屏，张军，岳惠忠，高文燕

单位：

030024 山西省太原市，山西省心血管病医院体外循环科

Units：

Cardiopulmonary Bypass, Shanxi Cardiovascular Disease Hospital, Taiyuan 030024, China

关键词：

风湿性心脏病；心瓣膜替换术；体外循环；HTK 液；含血St.Thomas 液；对比研究

Keywords：

Rheumatic heart disease; Cardio heart valve replacement; Cardiopulmonary bypass; HTK solution;Comparative study

CLC：

R 541.2

DOI：

10.12114/j.issn.1008-5971.2021.00.128

Funds：

摘要：

背景　心脏瓣膜置换术（CVR）是当前治疗风湿性心脏病（RHD）的首选方案，但该术式需要建立体 外循环，可能造成心肌缺血再灌注损伤（MIRI）。因此，RHD 患者CVR 中采取合适的心肌保护措施非常重要。目的 　比较HTK 液与含血St.Thomas 液在RHD 患者CVR 中的心肌保护作用。方法　选取2019—2020 年山西省心血管病 医院体外循环科收治的行CVR 的240 例RHD 患者作为观察组，术中应用HTK 液；另选取2017—2018 年本院收治的 行CVR 的225 例RHD 患者作为对照组，术中应用含血St.Thomas 液。比较两组患者术后1 个月临床疗效，主动脉阻 断前及术后2、12、24、48、72 h 心肌损伤指标〔包括肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白T（cTnT）、肌红 蛋白（MYO）〕，术前、术后1 个月心功能指标〔包括左心室射血分数（LVEF）、左心室收缩末期内径（LVESD）、 左心室舒张末期内径（LVEDD）〕；记录两组患者主动脉阻断时间、心脏复跳时间、心脏自动复跳发生率、心律失常 发生率及术后多巴胺剂量、并发症发生率。结果　观察组患者总有效率高于对照组（P ＜ 0.05）。时间与方法在血清 CK-MB、cTnT、MYO 水平上存在交互作用（P ＜ 0.05）；时间与方法均在血清CK-MB、cTnT、MYO 水平上主效应显 著（P ＜ 0.05）。术后2、12、24 h 观察组患者血清CK-MB、cTnT 水平低于对照组，术后2、24、48、72 h 观察组患 者血清MYO 水平低于对照组（P ＜ 0.05）。观察组患者术后1 个月LVEF 高于对照组，LVESD、LVEDD 小于对照组 （P ＜ 0.05）。观察组患者心脏复跳时间短于对照组，心脏自动复跳发生率高于对照组，心律失常发生率低于对照组， 术后多巴胺剂量少于对照组（P ＜ 0.05）。观察组患者并发症发生率为2.50%（6/240），低于对照组的8.89%（20/225） （P ＜ 0.05）。结论　与含血St.Thomas液相比，将HTK液用于RHD患者CVR中可有效提高其临床疗效，减轻心肌损伤， 促进心功能恢复，缩短体外循环时间，且术后并发症发生风险低。

Abstract：

Background　Cardio valve replacement (CVR) is currently the first choice for treatment of rheumatic heart disease (RHD) , but the operation needs to set up extracorporeal circulation, which may cause myocardial ischemiareperfusion injury (MIRI) . Therefore, it is very important to take appropriate myocardial protection measures in CVR of RHD patients. Objective　To compare the myocardial protection of HTK solution and blood-containing St.Thomas solution in CVR for patients with RHD. Methods　A total of 240 cases of RHD patients receiving CVR in Cardiopulmonary Bypass of Shanxi Cardiovascular Disease Hospital from 2019 to 2020 were selected as the observation group, and 225 cases of RHD patients receiving CVR in Shanxi Cardiovascular Disease Hospital from 2017 to 2018 were selected as the control group, the two groups were given HTK solution and blood-containing St. Thomas solution during operation, respectively. The clinical efficacy 1 month after operation, myocardial injury indexes [including creatine kinase isoenzyme (CK-MB) , cardiac troponin T (cTnT) and myoglobin (MYO) ] before aortic occlusion and 2 h, 12 h, 24 h, 48 h, 72 h after operation, and cardiac function indexes [including left ventricular ejection fraction (LVEF) , left ventricular end systolic diameter (LVESD), left ventricular end diastolic diameter (LVEDD) ] before operation and 1 month after operation were compared between the two groups; the time of aortic occlusion, time of cardioversion, incidence of automatic cardioversion, incidence of arrhythmia, dose of dopamine and incidence of complications after operation of the two groups were recorded. Results　The total effective rate of the observation group was significantly higher than that of the control group (P < 0.05) . There were statistically significant interaction between time and method in serum levels of CK-MB, cTnT and MYO (P < 0.05) ; main effects of time and method were statistically significant in serum levels of CK-MB, cTnT and MYO (P < 0.05) . The serum levels of CK-MB and cTnT in the observation group were lower than those in the control group at 2 h, 12 h and 24 h after operation, and the serum MYO level in the observation group was lower than that in the control group 2 h, 24 h, 48 h and 72 h after operation (P < 0.05) . One month after operation, LVEF of the observation group was higher than that of the control group, LVESD and LVEDD of the observation group were less than those of the control group (P < 0.05) . The time of cardioversion of the observation group were shorter than those of the control group, and incidence of automatic cardioversion was higher than that of the control group, and incidence of arrhythmia and dose of dopamine after operation were lower than those of the control group (P < 0.05) . The incidence of complications in the observation group was 2.50% (6/240) , which was lower than 8.89% (20/225) in the control group (P < 0.05) .Conclusion　Compared with blood-containing St.Thomas solution, HTK solution used in CVR of RHD patients can effectively improve its clinical efficacy, reduce myocardial injury, promote the recovery of cardiac function, shorten the time of cardiopulmonary bypass, and reduce the risk of postoperative complications.

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