张 蔚，于新迪，沈 佳，朱德明



三种心肌保护液在儿童心脏手术中的应用观察

张 蔚，于新迪，沈 佳，朱德明

［摘要］：目的 观察进口HTK心肌保护液(康斯特液)、国产HTK心肌保护液(赫特金液)和冷含血心肌保护液(Del Nido 液)在儿童心脏手术中对心肌的保护效果。方法 儿童心脏手术患者随机分为三组,每组20例。分别为康斯特液组、赫特金液组、Del Nido液组。测定体外循环中和结束后的心肌相关因子(肌钙蛋白、肌酸磷酸激酶、乳酸脱氢酶)的水平,测定手术后的脑钠肽水平。主动脉开放后随机抽取三组7例患者选取部分心肌组织,观察心肌缺血后光学显微镜下结构的变化。观察临床心脏自动复跳率、体外循环撤离时的正性肌力药物评分、术后呼吸机使用时间、监护室滞留时间。结果 三种心肌保护液在体外循环中和结束后的心肌相关因子的检测结果中无差异。使用赫特金液的患者手术后正性肌力药物的浓度明显小于Del Nido液的患者。在细胞结构光学显微镜下的变化中,赫特金液和康斯特液明显优于Del Nido液,细胞结构相对完整、破坏少、慢性炎性因子浸润不明显。结论 赫特金液和康斯特液的心肌保护作用相当,对心肌的保护作用要优于Del Nido液。

［关键词］：心肌保护；心脏停搏液；HTK液

Observation of three kinds of cardioplegia in the application inpediatric cardiac surgery

Zhang Wei,Yu Xin-di,Shen Jia,Zhu De-ming
Department of Extracorporeal Circulation,Department of Cardiothoracic Surgery,Shanghai Children＇s Medical Center,ShanghaiJiaotong University School of Medicine,Shanghai 200127,China
Corresponding author:Zhu De-ming,Email:scmccpbzhu@ aliyun.com

［Abstract］：Objective To observe the cardioprotective effect of imported Custodiol HTK solution ,domestic HTK solution(He Te Jin) and blood cardioplegia(Del Nido Solution) in pediatric cardiac surgery.Methods Sixty patients were randomly divided into 3 groups,twenty patients every group.Group 1:Custodiol HTK solution；Group 2:domestic HTK solution；Group 3:Del Nido solution.The serum myocardial associated factors(cTnI,CK,LDH) were evaluated during CPB and post operation.Post-operative serum BNP was also evaluated.The myocardialsample was taken right after the aorta was declamped.Seven patients＇samples from three groups were collected to observe the myocardial ischemic structural changes underoptical microscopy.The spontaneous normal rhythm recovery rates,the inotropic scores(IS) atweaning from CPB,the length of mechanical ventilation and ICU stay were recorded.Results No difference was found among the three groups in the serum levels of myocardial factors.The IS of Group 2 was obviously lower than that of Group 3.Comparing the cellular structural changes underoptical microscopy,the results of Group 1 and Group 2 were significantly better than that of Group 3 and the cellular structure wasrelatively intact,less damaged,and the infiltrated inflammatory cells were not obviously present in the HTK Groups.Conclusion The imported Custodiol HTK solution and the domestic HTK solution(He Te Jin) had similar myocardial protective effects,and both of them were superior to the Del Nido solution.

［Key words］： Myocardial protection；Cardioplegia；HTK solution

赫特金液是国内仿制研发生产的细胞内液型心肌保护液,其所含有的离子成份、浓度和进口HTK心肌保护液(康斯特液)相同,以低钾低钠微钙为特点。本研究将赫特金液和康斯特液、Del Nido液的心肌保护作用在儿童体外循环心脏手术中进行比较。……