冷HTK液与反复温血停搏液在新生儿主动脉转位手术中的应用
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Cold Histidine-Tryptophan-Ketoglutarate Solution and Repeated Oxygenated Warm Blood Cardioplegia in Neonates With Arterial Switch Operation
背景与目的
研究目的通过对心肌肌钙蛋白-1的释放和两组进行主动脉转换手术的新生儿短期效果来评估HTK液和反复温血停搏液灌注对的心肌保护作用。
方 法
共有218名新生儿被纳入2007年2月到2011年2月的回顾性研究。所有分析均按手术类 型分层 (ASO ±室间隔缺损修补±主动脉弓修复)。在手术的第一周内肌钙蛋白浓度使用混合 模型进行重复测量。为了消除冠状动脉的解剖学影响，在1:1匹配后进行敏感度分析。
结 果
总共30例病人使用了HTK液和188例病人使用了温血停搏液。高风险冠状动脉解剖（单 右冠状动脉向左上升，壁内通道）与高肌钙蛋白浓度升高和术后30天死亡率更高有关，与温血 停搏组相比,HTK 组更为明显。冠脉吻合前(p < 0.001)和冠脉吻合后(p = 0.03)HTK组术后 肌钙蛋白浓度均较高。HTK组死亡率更高，10%比1.1%( p = 0.009)，但仅在匹配后发现不显著 的趋势。
结 论
在接受 ASO 的新生儿中HTK停搏液与温血停搏相比，肌钙蛋白大量释放, 提示心肌保 护较差。30天死亡率的差异并不归因于使用了HTK液。
原始文献摘要
Background:
The present study aimed to compare myo- cardial protection, as assessed by cardiac troponin-I re- lease, and short-term outcomes between two groups of neonates undergoing the arterial switch operation (ASO) with either Custodiol cardioplegia (Custodiol HTK, Köhler Chemie GmbH, Bensheim, Germany) or repeated oxygenated warm blood cardiop:Cold Histidine-Tryptophan-Ketoglutarate Solution and Repeated Oxygenated Warm Blood Cardioplegia in Neonates With Arterial Switch Operation
Methods:
A total of 218 neonates were enrolled retro- spectively from February 2007 through February 2011. All analyses were stratified on the type of procedure (ASO ± ventricular septal defect closure ± aortic arch repair). Troponin concentrations within the first week of surgery were analyzed using mixed models for repeated mea- surements. To counteract the confounding effect of the coronary anatomy, a sensitivity analysis was conducted after 1:1 matching.
Results:
Overall 30 patients had Custodiol cardioplegia, and 188 had warm blood cardioplegia. High-risk coronary anatomy (single right coronary artery giving rise to the left, intramural course) was associated with higher troponin concentrations and a higher 30-day mor- tality rate postoperatively, and was more prevalent in the Custodiol group when compared with the warm blood cardioplegia group. Postoperative troponin concentra- tions were higher in the Custodiol group both before (p < 0.001) and after matching on the coronary anatomy (p = 0.03). The 30-day mortality rate was higher in the Custodiol group, 10% versus 1.1% (p = 0.009), but only a nonsignificant trend was noted after matching.
Conclusions:
The use of Custodiol cardioplegia in neonates undergoing ASO was associated with a larger troponin release when compared with warm blood car- dioplegia, suggesting poor myocardial protection. The difference noted in 30-day mortality was not due to the use of Custodiol.
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贵州医科大学高鸿教授课题组
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