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目的比较康斯特保护液(HTK液)和托马斯液(ST.Thomas液)在婴幼儿心内直视手术中对心肌的保护作用。方法选取40例VSD婴幼儿,分为实验组(HTK液)20例和对照组(ST.Thomas液)20例。患儿均采用常规全身麻醉。体外循环(CPB)采用中度低温。肝素化后常规建立CPB。升主动脉阻断后,经主动脉根部顺行灌注停搏液。实验组灌注HTK液30～50mL·kg-1,灌注时间持续6～8min。对照组灌注ST.Thomas液10～15mL·kg-1。观察指标包括主动脉开放后心脏自动复跳率、术后呼吸机支持时间及ICU监护时间。并对结果进行统计分析。结果 2组患儿CPB时间及主动脉阻断时间比较差异均无统计学意义(Pa>0.05)。2组患儿主动脉开放后心脏自动复跳率实验组显著高于对照组(P<0.05)。实验组辅助循环时间、停CPB后多巴胺剂量、术后呼吸机支持时间和ICU监护时间均少于对照组,差异均有统计学意义(Pa<0.05)。结论 HTK液可减轻未成熟心肌的缺血再灌注损伤,有利于早期心功能的恢复。与传统的ST.Thomas液比较,其对婴幼儿的未成熟心肌的保护作用更强。
Objective To compare the protective effects of CONSTANT (HTK solution) and Thomas (ST.Thomas solution) on myocardium in infants undergoing open heart surgery. Methods 40 cases of VSD infants and young children were divided into experimental group (HTK solution) 20 cases and control group (ST.Thomas solution) 20 cases. Children underwent general anesthesia. Cardiopulmonary bypass (CPB) with moderate low temperature. CPB was routinely established after heparinization. After the ascending aorta is blocked, the aortic root is infused with cardioplegic solution. Experimental group perfusion HTK solution 30 ~ 50mL · kg-1, perfusion time lasted 6 ~ 8min. The control group was infused with 10-15 mL · kg-1 ST.Thomas solution. Observations included the rate of spontaneous rebound after aortic opening, postoperative ventilator support time, and ICU monitoring time. And statistical analysis of the results. Results There was no significant difference in CPB time and aortic block time between two groups (Pa> 0.05). The rate of spontaneous rebound in the two groups of children after aortic opening was significantly higher than that in the control group (P <0.05). The assistant cycle time, dopamine dose after stopping CPB, postoperative ventilator support time and ICU monitoring time in the experimental group were all less than those in the control group, with significant differences (Pa <0.05). Conclusion HTK solution can reduce the ischemia-reperfusion injury of immature myocardium, which is beneficial to the recovery of early cardiac function. Compared with the traditional ST.Thomas solution, it has stronger protective effect on infants’ immature myocardium.