Guajardo Salinas Gustavo E, Nutt Roger, Rodriguez-Araujo Gerardo
Arkansas Heart Hospital, Little Rock, AR, USA.
Perfusion. 2017 Jan;32(1):68-73. doi: 10.1177/0267659116661051. Epub 2016 Jul 28.
Single-dose del Nido cardioplegia has been used in the pediatric population for many years. Only a small amount of data exists about its use in adult cardiac surgery. We sought to compare the outcomes of all patients undergoing coronary artery bypass, using our 4:1 blood cardioplegia versus single-dose 1:4 del Nido cardioplegia, at our institution.
Data were retrospectively reviewed from all patients during 2 consecutive years (2013-2014). We switched our cardioplegia protocol from 4:1 blood cardioplegia to exclusively 1:4 single-dose del Nido cardioplegia in early 2014. A total of 408 patients were evaluated. Two hundred and forty-nine consecutive patients underwent coronary artery bypass using blood cardioplegia and 159 using del Nido Cardioplegia.
Cardiopulmonary bypass time, cross-clamp time, in-hospital mortality and length of stay were similar (p>0.05): 63 ± 23 vs. 65 ± 21 min, 50 ± 20 vs. 52 ± 20 min, 0.8% vs. 0.6% and 6.4 ± 3 vs. 5.8 ± 3 days, respectively. For secondary outcomes: patients requiring defibrillation was 105/249 (42%) vs. 13/159 (8%) (p<0.0001), blood transfusion was required in 96/249 (38%) vs. 48/159 (30%) (p<0.085), total volume administered was 1139mL vs. 813 mL per case (p<0.0001), hematocrit change was 11.6% vs. 10.9% (p<0.04) and the mean cost per dose was $157.54 vs $5.74.
Single-dose del Nido cardioplegia is an effective and economic cardioplegia and can be used with good outcomes in coronary surgery. Most patients have spontaneous return of sinus rhythm and there is a trend towards decreased transfusion rate.
单剂量德尔尼多停搏液已在儿科人群中使用多年。关于其在成人心脏手术中的应用仅有少量数据。我们试图比较在我们机构接受冠状动脉搭桥术的所有患者使用我们的4:1血液停搏液与单剂量1:4德尔尼多停搏液的结果。
回顾性分析连续两年（2013 - 2014年）所有患者的数据。2014年初，我们将停搏液方案从4:1血液停搏液改为仅使用1:4单剂量德尔尼多停搏液。共评估了408例患者。249例连续患者使用血液停搏液进行冠状动脉搭桥术，159例使用德尔尼多停搏液。
体外循环时间、主动脉阻断时间、住院死亡率和住院时间相似（p>0.05）：分别为63±23分钟对65±21分钟、50±20分钟对52±20分钟、0.8%对0.6%以及6.4±3天对5.8±3天。对于次要结果：需要除颤的患者为105/249（42%）对13/159（8%）（p<0.0001），需要输血的患者为96/249（38%）对48/159（30%）（p<0.085），每例输注总量为1139毫升对813毫升（p<0.0001），血细胞比容变化为11.6%对10.9%（p<0.04），每剂平均成本为157.54美元对5.74美元。
单剂量德尔尼多停搏液是一种有效且经济的停搏液，可用于冠状动脉手术并取得良好效果。大多数患者窦性心律自发恢复，且有输血率降低的趋势。
