摘要
Abstract
Objective To summarize the protection effect of HTK solution on immature myocardium in cardiac operation of infants.Methods From January 2013 to October 2013,74 infants with congenital heart disease underwent operation,were divided into two groups: Modified St.Thomas Ⅱ solution group (group A) and HTK group (group B).The age of patients at cardiac operation time was below 3 months.The diagnosis included ventricular septal defect (VSD),atrial septal defect (ASD),tetralogy of Follot (TOF),double outlet right ventricle (DORV),complete atrioventficular septal defect (CAVC),etc.The moderate hypothermia was maintained during cardiopulmonary bypass (CPB).In group A,myocardial protection during CPB was dependent on single time St.Thomas Ⅱ solution (-20 ml/kg) perfusion.In the group B,it was dependent on HTK solution perfusion with the pressure of —— 80 to 90 mmHg to make cardiac arrest and 30 to 40 mmHg to maintain,lasting 5-7 minutes.Blood samples were collected to measure the serum level of cardiac troponin Ⅰ(cTnⅠ),creative kinase MB (CKMB),and lactate dehydrogenase (LDH) after anesthesia,24 and 72 hours after operation,respectively.Clinical parameters including the auto-resucitation ratio,inotropic support requirement,mechanical ventilation duration,and the stay time in the intensive care unit were recorded.Ejection fraction (EF) was measured preoperatively.The cadiocytes' mitochondria of right atrial appendage evaluated by Flameng's method,were observed by electron microscope prior to the aorta clamped (Time 1) and before CPB termination (Time 2).Results The level of CKMB,LDH and cTnⅠin group B at the time of 24 hours after operation were lower than those in group A.In the clinical parameters,the EF showed that the myocardial damage in group B was less than that in group A.At Time 1,the structure of mitochondria maintained as originally,loss of matrix granule and swelling of mitochondria were found by chance.At Time 2,damage in mitochondria was found,such as loss of matrix granule and cristae broken or spongiform.The scores of evaluation by Flameng's were increased in both groups (P<0.01).The scores of group A was higher than that of group B (P<0.05).Conclusion The protective effect of HTK solution on immature myocardial in infants with congenital heart disease is obviously better than St.Thomas Ⅱsolution.关键词
心肌灌注/心肌保护/先天性心脏病/婴幼儿/未成熟心肌Key words
Cadioplegia/Myocardial protection/Congenital heart disease/Infants/Immature myocardium
