康斯特保护液及晶体或含血停搏液作用比较.docVIP

康斯特保护液及晶体或含血停搏液作用比较 　【摘要】 目的康斯特保护液（HTK液）作为心脏停搏液与晶体或冷血心脏停搏液作用的比较。方法应用HTK液（HTK液组）25例，晶体或冷血心脏停搏液（对照组）25例。手术种类：二尖瓣和主动脉瓣置换术，二尖瓣置换术，主动脉瓣置换术，左房粘液瘤切除术，室间隔缺损修补术，房间隔缺损修补术。灌注方法：两组麻醉方式相同，体外循环采用中度低温，鼻咽温度和肛温＜30℃时阻断升主动脉，同时主动脉根部进行顺行或经冠状动脉开口直接灌注。对照组按400 ml/m2灌注心脏晶体或冷血心肌麻痹液，每30 min灌注一次；HTK液组用4℃～8℃的HTK液按30～40 ml/kg以100 mm Hg的灌注压力进行灌注并在10 min内结束，如果升主动脉阻断时间超过120 min，或出现心电活动再进行灌注。观察的指标：体外循环后心脏自动复跳率，术后应用正性肌力药物，术后监护天数。结果自发性复跳率无差别，HTK液组正性肌力药物，术后监护的天数与对照组差异明显。结论HTK液可以明显地保护心肌功能, 但是心脏自动复跳率较低与文献报道有矛盾, 这可能与这组研究的资料样本小有关,有待于进一步研究。其缺点容易造成血液稀释，尤其在婴幼儿患者，而且产品价格较昂贵限制了在临床的广泛应用。 【关键词】 HTK液；心肌保护；晶体心脏停跳液 　　To Compare the Effect of HTK and Crystalloid/Blood Cardioplegic Solution 　　Abstract: OBJECTIVEThe aim is to compare the effect of HTK (Histidine-Triptophan-Ketoglutalate) and crystalloid/blood cardioplegic solution.METHODS50 patients were divided into two groups. HTK solution group（n=25）and crystalloid solution group（n=25）.These patients undergoing open heart surgery such as DVR,MVR,AVR,LAM,VSD,ASD.The moderate hypothermia 28℃～32℃of the body was maintained during CPB. In the HTK group, perfused 30～40 ml/kg in 6～8 min as a single dose, and was repeated when the cardiac electrical action appeared.The crystalloid solution was perfused every 20～30 minus at 15ml/kg. The incidence of inotropic support requirement after operation,and the days stayed in the intensive care unit were evaluated.RESULTSThe aorta cross-clamping time and the number of heart autobeat was not different between the HTK group and crystalloid solution group (Pgt;0.05) . The number of patients required inotropic support in HTK group was very lower than in crystalloid solution group（Plt;0.05）. Mean days in ICU were （2.1±1.8） for the HTK group and （5±2.8） for the crystalloid solution group（Plt;0.05）.CONCLUSIONThe effective myocardial protection was achieved by use of HTK solution, however it can cause hemodilution in infant and the price of the HTK solution was more expensive than crystalloid solution. 　　Key words：HTK solution;Cardiac protec