| Objective:To compare the myocardial protective effects of Del Nido and modified St.Thomas in adult heart valve replacement surgery,and to analyze the effects of Del Nido on myocardial injury,oxidative stress and prognosis during and after adult heart valve replacement surgery.Methods:Clinical data of 180 patients aged between 18 and 75 years who underwent open heart valve replacement under cardiopulmonary bypass for the first time in the Department of Cardiovascular Surgery of Suining Central Hospital from January 2019 to October 2020 were collected and randomly divided into two groups.92 cases were treated with Del Nido pleural fluid(DN group)and 88 cases were treated with modified St.Thomas pleural fluid(STH group).In DN group,Del Nido crystal liquid was mixed with oxygenated blood at a rate of 4:1(4 parts of crystal and 1 part of blood),with the initial induction dose of 20ml/kg and the maximum dose of no more than 1000ml.The aortic occlusion was maintained with 10mL/kg reperfusion over 90min.In STH group,a 4:1 blood-cooled crystal was used to improve St.Thomas pleural fluid(4 parts of blood and 1 part of crystal).The first induction dose was 15 mL/kg.When the time was over 30min,10 mL/kg repeated infusion was used for maintenance.The contents of Cardiac troponin I(cTnI),Malondialdehyde(MDA)and Superoxide dismutase(SOD)in blood were collected 24 hours before surgery,6 hours after surgery,24 hours after surgery and 7 days after surgery.At the same time,a number of perioperative clinical data of the two groups were collected,and the changes of cTnI,MDA,SOD before and after surgery,as well as the differences of other clinical indexes between the two groups were analyzed and compared by statistical methods.Results:1.During the operation of single valve replacement,the Cardiopulmonary bypass(CPB)time,aortic cross clamp(ACC)time and operation time of patients in the DN group were shorter than those in the STH group,but the differences were not statistically significant,and the perfusion times and total perfusion dose were less than those in the STH group.The difference was statistically significant(P<0.05).In double valve replacement,the CPB time,ACC time and operation time in DN group were shorter than those in STH group,and the perfusion times and total perfusion dose were less than those in STH group,with statistical significance(P<0.05).3.Plasma cTnI in both groups increased significantly after surgery and continued to increase 24 hours after surgery.It decreased significantly 7 days after surgery compared with 24 hours after surgery,but was still higher than the preoperative level.The level of cTnI in DN group was lower than that in STH group at 7 days after surgery,and there was no significant difference in cTnI levels between the two groups at other time points.4.The level of MDA in 2 groups was significantly higher at 6 h postoperatively than before,decreased significantly at 24 h postoperatively compared with 6 h postoperatively,and decreased to the preoperative level at 7 days postoperatively.The MDA level in DN group was lower than that in STH group at 6 and 24 hours after surgery,and there was no significant difference in MDA level between the two groups at other time points.5.SOD in both groups decreased significantly 6 h after surgery,increased significantly 24 h after surgery compared with 6 h after surgery,and increased to the preoperative level 7 days after surgery.The SOD level of DN group was lower than that of STH group at 6 and 24 hours after surgery,and there was no significant difference between the two groups at other time points.Conclusion:1.Del Nido cardiopleural fluid has longer ischemia tolerance time and less perfusion times,and still has the myocardial protective effect as the modified St.Thomas cardiopleural fluid.2.Del Nido cardioplegia has more obvious advantages in double valve replacement.3.Del Nido cardioplegia was more effective in alleviating myocardial oxidative stress injury. |
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