Ramani Jaydip, Malhotra Amber, Wadhwa Vivek, Sharma Pranav, Garg Pankaj, Tarsaria Malkesh, Pandya Himani
Department of Cardiovascular and Thoracic Surgery of U.N. Mehta Institute of Cardiology and Research Center (Affiliated to B.J. Medical College), Civil hospital Campus, Asarwa, Ahmedabad, India.
Braz J Cardiovasc Surg. 2017 Mar-Apr;32(2):90-95. doi: 10.21470/1678-9741-2016-0025.
: Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement.
: A total of 110 patients who underwent single (aortic or mitral) valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients), long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients), standard St Thomas IB (short-acting blood-based cardioplegia solution) was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters.
: We did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43) and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23) in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65) in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB), Troponin-I levels, lactate level and cardiac functions postoperatively.
: This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.
心肌保护在心脏手术中最为重要。我们在接受单瓣膜置换术的患者中，将改良的基于单剂量长效利多卡因的血液停搏液与短效的圣托马斯1号血液停搏液进行了比较。
共纳入110例行单（主动脉或二尖瓣）瓣膜置换手术的患者。根据所使用的停搏液将患者分为两组。在第1组（56例患者）中，给予单剂量的基于长效利多卡因的血液停搏液，而在第2组（54例患者）中，给予标准的圣托马斯1B号（短效血液停搏液），并每20分钟重复给药一次。比较所有患者的术前基线参数、术中及所有术后参数。
我们未发现术前基线参数有任何统计学上的显著差异。第1组和第2组的体外循环时间分别为73.8±16.5分钟和76.4±16.9分钟（P = 0.43），主动脉阻断时间分别为58.9±10.3分钟和66.3±11.2分钟（P = 0.23）。第1组和第2组的最大血管活性药物评分平均值分别为6.3±2.52和6.1±2.13（P = 0.65）。我们在术后的肌酸磷酸激酶同工酶（CPK-MB）、肌钙蛋白I水平、乳酸水平及心功能方面也未发现任何统计学上的显著差异。
本研究证明，在需要进行单瓣膜置换的患者中，与标准的短效多剂量血液停搏液相比，基于长效利多卡因的单剂量血液停搏液具有安全性和有效性。需要进一步开展研究，以确定在复杂心脏手术尤其是病情较重患者的情况下这种非劣效性。
