del Nido 与 Buckberg 心脏停搏液在成人孤立瓣膜手术中的应用比较。

del Nido versus Buckberg cardioplegia in adult isolated valve surgery.

机构信息

Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.

出版信息

J Thorac Cardiovasc Surg. 2015 Feb;149(2):626-634; discussion 634-6. doi: 10.1016/j.jtcvs.2014.10.085. Epub 2014 Oct 22.

DOI:10.1016/j.jtcvs.2014.10.085

PMID:25483897

Abstract

BACKGROUND

del Nido solution is a non-glucose-based, single-dose cardioplegic solution with few data supporting its safety in adults. We hypothesized that it and Buckberg solution offer myocardial protection of equivalent safety for isolated adult valve surgery.

METHODS

Adult patients undergoing primary isolated aortic or mitral valve surgery with del Nido or Buckberg solution from January 2010 to September 2013 were 1:1 propensity matched (85 aortic valve, 110 mitral valve), and outcomes were compared.

RESULTS

After aortic valve operations, no hospital deaths occurred, and troponin T levels (median 0.19 ng · mL(-1) for del Nido vs 0.21 ng · mL(-1) for Buckberg) were similar, with no statistically significant change in left ventricular ejection fraction (P = .4). Aortic clamp, bypass, and operating room times were shorter with del Nido solution (44 ± 14 vs 56 ± 19; 56 ± 18 vs 70 ± 24; and 285 ± 44 vs 308 ± 61 minutes, respectively; P < .0001). Peak intraoperative glucose levels (170 ± 31 vs 240 ± 41 mg · dL(-1); P < .0001) and postoperative insulin-drip requirements (46% vs 82%; P < .0001) were lower. After mitral operations, there were no hospital deaths and no statistically significant cardioplegia-specific changes in troponin T levels (median 0.37 ng · mL(-1) for del Nido vs 0.4 ng · mL(-1) for Buckberg) or postoperative left ventricular ejection fraction (P = .13). We found no clear time differences with del Nido solution in mitral cases, but intraoperative glucose levels and postoperative insulin-drip requirements (184 ± 37 vs 250 ± 60 mg · dL(-1) and 50% vs 67% mg · dL(-1), respectively; P = .009) were lower.

CONCLUSIONS

del Nido solution can be used safely and effectively as an alternative to Buckberg solution in adult isolated valve surgery and is associated with lower insulin requirements and potential time and cost savings.

摘要

背景

del Nido 溶液是一种不含葡萄糖的单次剂量心脏停搏液，其在成人中的安全性数据有限。我们假设它和 Buckberg 溶液在成人瓣膜手术中提供同等安全的心肌保护。

方法

2010 年 1 月至 2013 年 9 月期间，接受 del Nido 或 Buckberg 溶液的成人原发性孤立性主动脉瓣或二尖瓣手术的患者按 1:1 倾向匹配（85 例主动脉瓣，110 例二尖瓣），并比较其结果。

结果

主动脉瓣手术后，无院内死亡，troponin T 水平（del Nido 中位数为 0.19ng·mL(-1)，Buckberg 中位数为 0.21ng·mL(-1)）相似，左心室射血分数无统计学意义变化（P =.4）。del Nido 溶液的主动脉夹闭、体外循环和手术时间更短（分别为 44 ± 14 对 56 ± 19；56 ± 18 对 70 ± 24；285 ± 44 对 308 ± 61 分钟；P <.0001）。术中血糖峰值（170 ± 31 对 240 ± 41mg·dL(-1)；P <.0001）和术后胰岛素滴注需求（46%对 82%；P <.0001）较低。二尖瓣手术后，无院内死亡，troponin T 水平（del Nido 中位数为 0.37ng·mL(-1)，Buckberg 中位数为 0.4ng·mL(-1)）或术后左心室射血分数（P =.13）无统计学意义变化。我们发现，在二尖瓣病例中，del Nido 溶液没有明显的时间差异，但术中血糖水平和术后胰岛素滴注需求（184 ± 37 对 250 ± 60mg·dL(-1)和 50%对 67%mg·dL(-1)；P =.009）较低。