| Objective: To compare the myocardial protective effect of Histidine-tryptophan-ketoglutarate solution(HTK solution)and Cold blood-containing cardioplegia solution in patients with aortic valve stenosis,and provide evidence for clinical myocardial protection Individualized perfusion strategy.Methods: This study was a prospective,non-randomized,single blind controlled study.Eighty-two Patients who underwent Aortic valve replacement(AVR)with cardiopulmonary bypass(CPB)in the Department of Cardiovascular and Vascular Surgery,the Second Hospital of Hebei Medical University from from November 2018 to October 2020 were divided into the HTK group(41 patients)and the cold blood-containing St.Thoms group(41patients).In addition to the difference of cardioplegia solution,the standard of surgical method,anesthesia method,establishment and implementation of CPB,and monitoring of vital signs were unified.The serum CKMB and c Tn I values were detected immediately after operation,the first day and the second day after operation.In addition,the number of intraoperative defibrillation,operation time,duration of CPB,acending aorta clamping(ACC),cross clamping removing(CCR)and auxiliary circulation,changes of the cardiac index(CI)before and after operation,incidence of postoperative ventricular arrhythmias,postoperative pericardial mediastinal drainage volume,ventilator assisted time,ICU treatment time and postoperative hospital stay were collected for statistical analysis.Results:1.There were no significant differences in gender distribution,age,BMI and smoking history between the HTK group and the cold blood-containing St.Thomas group(P>0.05),and there were no statistically differences in hypertension,diabetes,hyperlipidemia,COPD and other previous medical histories.In preoperative examination,there was no significant difference in CI(P=0.693)and cardiothoracic ratio between the two groups(P=1.000).There was no statistical significance in NYHA classification between the two groups(P=0.477).2.The automatic rebound rate of the HTK solution group was significantly higher than that of the cold blood-containing St.Thomas group(80.50%Vs56.10%,P=0.018),and the total defibrillation frequency of the HTK solution group was significantly lower than that of the cold blood-containing St.Thomas group([0.24±0.538]Vs[1.20±3.378],P=0.015),The difference between the two groups is statistically significant.The time of operation,cardiopulmonary bypass and cross clamping removing in the HTK solution group was significantly less than that in the cold blood-containing St.Thomas group(P<0.05).According to the statistical description of the sample,the acending aorta clamping time of the HTK solution group were shorter than those of the cold blood-containing St.Thomas group,but the overall difference was not statistically significant.3.None of the patients died during hospitalization,and there was no heart rupture,conduction beam injury,coronary artery injury,or inability to stop the machine during the operation.There were no serious conditions such as low cardiac output syndrome,intra-aortic balloon pump,extracorporeal membrane oxygenation,and stroke in the early postoperative period.The serum CKMB and c TNI values of the HTK solution group on the first and second day after operation were lower than those of the cold blood-containing St.Thomas group(P<0.05).The incidence of postoperative ventricular arrhythmia was lower than that of the cold blood-containing St.Thomas group(2.4%Vs19.5%,P=0.034),and the postoperative ICU treatment time and postoperative hospital stay were shorter than the cold blood-containing St.Thomas solution group(P<0.05).Conclusions: The myocardial protective effect of HTK solution is better than that of cold blood-containing St.Thomas solution,and it has obvious advantages for intraoperative myocardial protection and early postoperative recovery. |
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