两种心脏停搏液在全胸腔镜心脏瓣膜手术中心肌保护作用的比较研究OA

Objective To compare the myocardial protective effects of Custodiol HTK(histidine-tryptophan-ketogluta-rate)cardioplegia and blood cardioplegia(BCP)when administered in totally thoracoscopic valve surgery.Methods Clinical data of 101 patients who underwent totally thoracoscopic valve surgery at Guangdong Provincial People's Hospital from January 2021 to December 2021 were retrospectively analyzed.Patients were divided into two groups according to the cardioplegia they adopted during operation,including group HTK(n=32)and group BCP(n=69).Postoperative outcomes represented by myocardial enzyme levels involving creatine kinase MB isotype(CK-MB)and cardiac troponin T(cTnT),left ventricular ejection fraction(LVEF),vasoactive-inotropic score(VIS),myocardial infarction(MI)and spontaneous return to sinus rhythm were compared between the two groups.Results 69 and 32 patients adopted blood cardioplegic and HTK solutions,respectively.The levels of CK-MB and cTnT at<24 h,24～48 h and>48 h after surgery,postoperative LVEF,VIS and incidence of MI were similar be-tween the two groups(P>0.05),but HTK administration was associated with a lower possibility of spontaneous return to sinus rhythm(P=0.018).Additionally,increased aortic cross-clamp time(every 10 minutes)was associated with a higher risk of MI(P=0.002)while increased total volume was associated with a lower risk of MI(P=0.029).Conclusion Delivery of HTK solu-tion offered equivalent myocardial protection to the blood cardioplegia in patients undergoing totally thoracoscopic valve surgery.Timely increased perfusion effectively reduced the incidence of early postoperative myocardial infarction following thoracoscop-ic surgery.