Prathanee Sompop, Kuptanond Chusak, Intanoo Worawit, Wongbhudha Chawalit, Karunasumaeta Chananya
J Med Assoc Thai. 2015 Aug;98 Suppl 7:S164-7.
Many steps of myocardial preservation during open heart surgery are practical after the development of the heart-lung machine. A cardioplegia solution, infused after aortic cross clamping, is an important aspect. Two-thirds of cardioplegia solutions are an intracellular solution (such as HTK or Bretschneider solution) or extracellular solution (such as blood cardioplegia). Intracellular cardioplegia solution can provide protection for 3-4 hours after one-time infusion, which differs from extracellular cardioplegia solution requiring intermittent use every 20-30 minutes.
Retrospective case-control study in CABG patients were reviewed in Cardiovascular and Thoracic Unit, Department of Surgery, Khon Kaen University during April 2011 and September 2012. The study group was divided into groups A and B, for myocardial protection by blood cardioplegia and Custodiol-HTK (Histidine-Tryptophan-Ketoglutarate) solutions. Baseline data such as age, sex, NYHA, risk factors, associated disease, operation, CPB time, aortic cross clamp time, complication, defibrillation after surgery, ICU stay, length of stay and mortality rate were analyzed.
The study patients in groups A and B were 60 and 65 cases. Defibrillation after finishing CABG in groups A, B was 8.3% and 33.8%. Mortality rate in groups A, B were 1.7% and 4.6%. Other post operative complications were similar in both groups.
There was significantly more spontaneous ventricular fibrillation after release of cross clamping in HTK group. Clinical outcome of single doses of antegrade, cold Custodiol-HTK cardioplegia solution in CABG surgery protected the myocardium equally well as repetitive antegrade, cold blood cardioplegia.
在体外循环机发展之后，心脏直视手术中心肌保护的许多步骤都切实可行。在主动脉交叉钳夹后注入心脏停搏液是一个重要方面。三分之二的心脏停搏液是细胞内液（如HTK或布雷施奈德液）或细胞外液（如血液心脏停搏液）。一次性注入细胞内心脏停搏液可提供3至4小时的保护，这与每20至30分钟需要间歇性使用的细胞外心脏停搏液不同。
对孔敬大学医学院心血管与胸外科2011年4月至2012年9月期间接受冠状动脉搭桥术（CABG）患者进行回顾性病例对照研究。研究组分为A组和B组，分别采用血液心脏停搏液和Custodiol-HTK（组氨酸-色氨酸-酮戊二酸）溶液进行心肌保护。分析年龄、性别、纽约心脏协会（NYHA）分级、危险因素、相关疾病、手术、体外循环时间、主动脉交叉钳夹时间、并发症、术后除颤、重症监护病房（ICU）停留时间、住院时间和死亡率等基线数据。
A组和B组的研究患者分别为60例和65例。A组和B组冠状动脉搭桥术结束后的除颤率分别为8.3%和33.8%。A组和B组的死亡率分别为1.7%和4.6%。两组的其他术后并发症相似。
HTK组在交叉钳夹松开后出现明显更多的自发性心室颤动。在冠状动脉搭桥手术中，单剂量顺行冷Custodiol-HTK心脏停搏液的临床结果对心肌的保护效果与重复顺行冷血液心脏停搏液相同。
