Effect Analysis Of Del Nido Cardioplegic In Coronary Artery Bypass Grafting Surgery

Object: To retrospectively analyze the clinical data of Del Nido cardioplegia and blood cardioplegia in coronary artery bypass grafting（CABG）under cardiopulmonary bypass,compare the myocardial protective effects of Del Nido cardioplegia and blood cardioplegia（4: 1）in CABG,evaluate the safety and effectiveness of Del Nido cardioplegia in adult CABG,and provide more evidence for its clinical application.Method: 51 patients who underwent CABG under cardiopulmonary bypass in our hospital from December 2017 to March 2021 were selected,including 21 patients with blood cardioplegia（BC group）and 30 patients with Del Nido cardioplegia（DN group）.The baseline data of patients in both groups before operation were recorded,including aortic cross-clamping time,cardiopulmonary bypass time,cardioplegia infusion doses and total infusion volume,auto-resuscitation rate,operation time,K+ concentration,blood glucose concentration,hemoglobin concentration,lactic acid and hematocrit before and after CPB,postoperative mechanical ventilation time,hospitalization time and other clinical indexes;in addition,serum creatine kinase myocardial band（CKMB）,cardiac troponin I（c Tn I）and left ventricular ejection fraction（LVEF）were measured at four time points: before operation（T0）,time point returning to ICU after operation（T1）,24 h after operation（T2）and 48 h after operation（T3）;complications such as atrial fibrillation,myocardial infarction,retrosternal infection,secondary intubation and secondary thoracotomy were observed and recorded.The data were statistically analyzed by SPSS 24.0 software,and the difference was considered to be statistically significant when P < 0.05.Result: 1.There were no differences in baseline data such as age,body weight,past medical history,stent implantation history and preoperative creatinine level between DN group and BC group（P > 0.05）.There were no differences in cardiac function grade distribution and EF value in preoperative echocardiography（P > 0.05）.2.The doses and volume of cardioplegia infusion and the demand of blood transfusion in DN group were lower than those in BC group（P < 0.05）,and the autoresuscitation rate was higher than that in BC group（P < 0.05）.There were no significant differences in operation time,aortic cross-clamping time,cardiopulmonary bypass time,K+ concentration,blood glucose concentration,hemoglobin concentration,lactic acid and hematocrit,mechanical ventilation time,ICU hospitalization time,creatinine level and postoperative complications between the two groups（P > 0.05）.3.The levels of myocardial enzymes in DN group were significantly lower than those in blood perfusion group at T1,T2 and T3（P < 0.05）.There was no significant difference in LVEF between the two groups（P > 0.05）.2 patients in the blood perfusion group underwent secondary thoracotomy to stop bleeding due to postoperative bleeding,1 patient in each group underwent continuous renal replacement therapy（CRRT）for prerenal renal failure,and 1 patient in each group died on the first day after operation.Conclusion: 1.Del Nido cardioplegia is safe and effective in CABG,and its myocardial protection effect is clear.2.The patients with Del Nido cardioplegia has higher auto-resuscitation rate,and the level of myocardial enzymes after operation is lower than that of blood cardioplegia,and the myocardial protection effect is better than that of blood cardioplegia.3.Compared with blood cardioplegia,Del Nido cardioplegia has less infusion time,which reduces the interference of repeated infusion to the operation process.4.Compared with blood cardioplegia,the demand for blood transfusion during operation is significantly reduced.