冠状动脉搭桥手术中使用德尔尼多心脏停搏液：一种安全、有效且经济的替代圣托马斯溶液的方法；来自一个发展中国家的经验。

Del Nido Cardioplegia in Coronary Artery Bypass Grafting Surgery: A safe, efficacious and economic alternative to St. Thomas solution; an experience from a developing nation.

作者信息

Moktan Lama Purna Bahadur, Khakural Prabhat, Sigdel Shailendra, Raj Bhatta Mahendra, Sah Teli Rabindra, Baral Ravi Kumar, Bhattarai Anil, Pradhan Bishwas, Koirala Bhagawan

机构信息

Department of Cardiothoracic Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.

Department of Cardiothoracic and Vascular Anesthesiology, Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal.

出版信息

Perfusion. 2021 Jul;36(5):470-475. doi: 10.1177/0267659121991033. Epub 2021 Jan 28.

DOI:10.1177/0267659121991033

PMID:33509043

Abstract

INTRODUCTION

del Nido cardioplegia is a newer solution getting popular worldwide, whereas in Nepal, St. Thomas cardioplegia solution is conventionally used. There is no national recommendation on cardioplegia solutions supported by evidences from Nepalese studies. This study aimed to evaluate and compare the efficacy of these solutions in Nepalese patients undergoing coronary artery bypass grafting.

METHODS

Patients undergoing coronary revascularization, from May 2018 to December 2019, were randomized into St. Thomas and del Nido groups based on the cardioplegia administered, with 45 patients in each group. Preoperative, intraoperative, and postoperative parameters and cost of cardioplegia preparation in the two groups were compared.

RESULTS

The cardiopulmonary bypass time (106.13 ± 24.65 minutes vs 107.62 ± 18.69 minutes, = 0.02), aortic cross clamp time (66.22 ± 15.40 minutes vs 72.07 ± 12.23 minutes, = 0.04), volume (1059.22 ± 100.30 ml vs 1526.67 ± 271.81 ml, < 0.001) and number of cardioplegia doses (1.00 ± 0.00 vs 2.51 ± 0.66, < 0.001) were significantly lower with del Nido cardioplegia. A lower CPK-MB at second post-operative (59.91 ± 31.62 vs 73.82 ± 37.25, = 0.03) and a higher left ventricle ejection fraction at discharge (56.33 ± 8.94% vs 50.45 ± 8.55%, < 0.001) was observed in del Nido group. There was one death in St. Thomas group. ICU and hospital stay were similar in both groups. St. Thomas solution was found to be costlier than del Nido solution (USD 5.40 ± 0.96 vs USD 3.50 ± 0.34, < 0.001).

CONCLUSION

The del Nido cardioplegia was found to be efficacious, safe and more economical alternative to St. Thomas solution.

摘要

引言

德尔尼多心脏停搏液是一种在全球范围内越来越受欢迎的新型溶液，而在尼泊尔，传统上使用的是圣托马斯心脏停搏液。目前尚无基于尼泊尔研究证据的关于心脏停搏液的国家推荐。本研究旨在评估和比较这些溶液在接受冠状动脉搭桥术的尼泊尔患者中的疗效。

方法

2018年5月至2019年12月接受冠状动脉血运重建的患者，根据所使用的心脏停搏液被随机分为圣托马斯组和德尔尼多组，每组45例。比较两组患者术前、术中和术后的参数以及心脏停搏液制备成本。

结果

德尔尼多心脏停搏液的体外循环时间（106.13±24.65分钟对107.62±18.69分钟，P=0.02）、主动脉阻断时间（66.22±15.40分钟对72.07±12.23分钟，P=0.04）、用量（1059.22±100.30毫升对1526.67±271.81毫升，P<0.001）和心脏停搏液剂量数（1.00±0.00对2.51±0.66，P<0.001）显著更低。德尔尼多组术后第二天的肌酸磷酸激酶同工酶（CPK-MB）更低（59.91±31.62对73.82±37.25，P=0.03），出院时左心室射血分数更高（56.33±8.94%对50.45±8.55%，P<0.001）。圣托马斯组有1例死亡。两组的重症监护病房（ICU）和住院时间相似。发现圣托马斯溶液比德尔尼多溶液成本更高（5.40±0.96美元对3.50±0.34美元，P<0.001）。