自体冷血停搏液对紫绀型先心病婴儿心脏的保护作用

Protective effect of cold autologous blood cardioplegic solution on the heart of infants with cyanotic congenital heart disease

摘要:

目的：探讨自体冷血停搏液对紫绀型先心病婴儿心脏的保护作用。 方法：96例行体外循环术的紫绀型先心病婴儿随机分为：HTK液组（HTK组，32例）、非自体冷血停搏液组（非自体组，32例）和自体冷血停搏液组（自体组，32例），阻断前和主动脉开放30 min取右心耳组织，检测ATP的含量及能量储备（EC）；术前和术后即刻取静脉血，测肌酸激酶同工酶（CK-MB）和心肌肌钙蛋白I（cTnI）的浓度；记录术中复跳时间、复跳率、术后 2 h心脏指数（CI）、正性肌力药物依赖情况和左室射血分数、术后24 h心律失常发生率、术后并发症及病死率等。结果：主动脉开放30 min后，3组ATP 和EC含量均显著降低（P<0.05），其中自体组较HTK组和非自体组高，差异有统计学意义（P<0.05）。3组术后即刻CKMB和cTnI血清浓度均显著增加（P<0.05），其中自体组较HTK组和非自体组低，差异具有统计学意义（P<0.05）。自体组在复跳时间、术后2 h正性肌力药物依赖及左心射血分数上优于HTK组和非自体组，差异具有统计学意义（P<0.05）。结论：在紫绀型先心病婴儿体外循环下，自体冷血停搏液比非自体冷血停搏液与HTK液能更好地保存心肌细胞能量，减轻心肌损伤，对心脏具有较好的保护作用。

Abstract:

OBJECTIVE: To study the protective effect of cold autologous blood cardioplegic solution on the heart of infants with cyanotic congenital heart disease (CCHD). METHODS: Ninety-six infants with CCHD who underwent cardiopulmonary bypass (CPB) were randomly and equally divided into three groups: histidine-tryptophan-ketoglutarate (HTK) solution, cold non-autologous blood cardioplegic solution, and cold autologous blood cardioplegic solution. The right auricular tissues were taken before aortic cross-clamping and at 30 minutes after aortic declamping, and ATP level and energy charge (EC) in the myocardium were measured. Venous blood was collected before and immediately after CPB, and the serum levels of creatine kinase (CK)-MB and cardiac troponin I (cTnI) were measured. The clinical parameters, such as the re-beat time and re-beat rate during CPB, cardiac index, dependence on positive inotropic agents, and left ventricular ejection fraction (LVEF) at 2 hours after CPB, the incidence rate of arrhythmia within 24 hours after CPB, and postoperative complications and mortality, were recorded. RESULTS: At 30 minutes after aortic declamping, the three groups showed significantly decreased ATP and EC levels (P<0.05), and the cold autologous blood group had significantly higher ATP and EC levels than the other two groups (P<0.05). Immediately after CPB, the three groups showed significantly increased serum levels of CK-MB and cTnI (P<0.05), and the cold autologous blood group had significantly lower serum levels of CK-MB and cTnI than the other two groups (P<0.05). The cold autologous blood group had significantly better outcomes than the other two groups in terms of the re-beat time during CPB and the dependence on positive inotropic agents and LVEF at 2 hours after CPB (P<0.05). CONCLUSIONS: Cold autologous blood cardioplegic solution is superior to HTK and cold non-autologous blood cardioplegic solutions in preserving myocardial energy and reducing myocardial injury in infants with CCHD who undergo CPB, thus providing a better protective effect on the heart.