| BackgroundValvular heart disease is one of the common types of heart disease.In recent years,with the changes in the spectrum of cardiovascular diseases in my country,the proportion of rheumatic heart valve disease has been relatively reduced,and degenerative heart valve disease（especially aortic valve stenosis and mitral valve regurgitation）has decreased.The incidence of coronary heart disease tends to increase,and the number of patients requiring mitral valve replacement under CPB increases.In open-heart surgery under CPB,myocardial ischemia-reperfusion injury affects the smooth recovery of postoperative cardiac function,and myocardial protection has become The top priority in cardiopulmonary bypass surgery,various cardioplegia solutions have certain effects on myocardial protection.Currently,the more commonly used cardioplegia solutions in clinical practice include Del Nido solution and St.Thomas solution.Del Nido cardioplegia solution was initially used.It has been used in pediatric cardiac surgery and is now gradually being used in adult cardiac surgery.The clinical data were collected for statistical analysis.ObjectiveTo explore the myocardial protective effect of Del Nido cardioplegia solution and St.Thomas cardioplegia solution,and to provide reference for the choice of cardioplegia solution for adult mitral valve replacement.MethodsIncluded in the Department of Cardiovascular Surgery of the First Affiliated Hospital of Xinxiang Medical College from April 2020 to June 2021,a total of 60 patients who need to undergo simple mitral valve replacement under cardiopulmonary bypass（CPB）.The patients were divided into tow groups by random number table method: Del Nido solution group（DN,30 patients）and St.Thomas solution group（ST,30 patients）.Except for the use of myocardial protective solution,the other standards were the same between the two groups of patients,and the myocardial protective effect was compared.The myocardial protection effects of the two groups were compared,and the following main data were collected: CPB time,aortic occlusion time,number of cardioplegia perfusion,Cardiac resuscitation after aortic opening;the following minor data were collected:concentrations of troponin I（c Tn I）and creatine phosphokinase isoenzyme（CK-MB）at the same time after surgery,occurrence of arrhythmia after operation,time of dopamine use after operation,intensive care unit stay time,mechanical ventilation time.Results1.There was no significant difference in age,gender and body weight between the DN group and ST group in the baseline data（P>0.05）,and there was no significant difference in the past history（hypertension,diabetes,hyperlipidemia）（P>0.05）,cardiac function class（P=0.855）,ejection fraction（P=0.836）were not significantly different,there was no statistical difference in preoperative biochemical indexes c Tn I concentration（P=0.401）,CK-MB concentration（P=0.795）There was no significant difference in preoperative cardiac ultrasound indicators（left atrial diameter,left ventricular end-systolic diameter,left ventricular end-diastolic diameter）（P>0.05）.2.There was no significant difference in cardiopulmonary bypass time（P=0.090）between the two groups,however,compared with ST group,the DN group had significantly fewer perfusion times（P<0.001）,shorter aortic occlusion time（P<0.001）,and cardiac autonomous The rebound rate was higher（P<0.05）.3.All patients in the two groups successfully completed simple mitral valve replacement without intraoperative or postoperative death.There were no significant differences in postoperative dopamine use time,intensive care unit stay time,and duration of mechanical ventilation between the two groups（P>0.05）;There was no significant difference in the postoperative biochemical indexes c Tn I concentration（P=0.515）and CK-MB concentration（P=0.425）between the two groups;However,compared with ST group,DN group was lower in occurrence of arrhythmia after operation（P<0.05）.ConclusionCompared with St.Thomas solution,Del Nido solution has the advantages of fewer perfusion times,shorter aortic occlusion time,accelerated cardiac resuscitation,and lower incidence of postoperative arrhythmias. |
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