组氨酸-色氨酸-酮戊二酸心脏麻痹与冷血心脏麻痹对接受手术修复的法洛氏四联症患者心肌保护作用的比较：随机临床试验

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia Pub Date : 2024-07-23 DOI:10.1053/j.jvca.2024.07.038

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引用次数: 0

摘要

目的本研究旨在比较组氨酸-色氨酸-酮戊二酸（HTK）心脏麻痹和冷血心脏麻痹（CBC）的疗效，尤其是对法洛氏四联症修复术后右心室（RV）功能的疗效。干预措施患者被分配（双盲 1:1 分配比例）到 HTK 组（通过前向途径接受 30 mL/kg HTK 心脏麻痹）或 CBC 组（接受血液与林格溶液（4:1）体积为 20 mL/kg 的冷血心脏麻痹）。测量和主要结果与 CBC 组（15.5 ± 5.4）相比，HTK 组在进入儿科重症监护室时血管活性肌力评分（13.0 ± 4.1）明显降低，P 值为 0.011。然而，24 小时后，血管活性-肌张力评分相当。在最初的 24 小时内，HTK 组的乳酸水平为 6.2 ± 0.7 mmol/L，CBC 组为 6.9 ± 0.4 mmol/L（p < 0.0001）。在术后 72 小时内，HTK 组的肌钙蛋白序列测量值（1.49 ± 0.45）低于 CBC 组（1.69 ± 0.18）（p = 0.005）。通过三尖瓣环平面收缩期偏移和心肌性能指数对 RV 功能进行术后超声心动图评估，HTK 组的效果优于 CBC 组（P < 0.05）。

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Comparison Between Histidine-Tryptophan-Ketoglutarate Cardioplegia and Cold Blood Cardioplegia for Myocardial Protection in Tetralogy of Fallot Patients Undergoing Surgical Repair: A Randomized Clinical Trial

Objectives

This study was conducted to compare the efficacy of histidine-tryptophan-ketoglutarate (HTK) cardioplegia and cold blood cardioplegia (CBC), especially for postoperative right ventricular (RV) function after tetralogy of Fallot repair.

Design

Randomized, double-blinded, parallel-group, controlled clinical trial.

Setting

Ain Shams University Hospitals.

Participants

A total of 100 children (1 to 5 years old) scheduled for tetralogy of Fallot repair.

Interventions

Patients were allocated (double-blinded 1:1 allocation ratio) to either the HTK group that received HTK cardioplegia (30 mL/kg via antegrade route) or the CBC group that received cold blood cardioplegia with blood-to-Ringer solution (4:1) in a volume of 20 mL/kg.

Measurements and Main Results

The HTK group showed a statistically significant reduction of the vasoactive inotropic score on admission to the pediatric intensive care unit (13.0 ± 4.1) in comparison to the CBC group (15.5 ± 5.4), with a p value of 0.011. However, after 24 hours, the vasoactive-inotropic score was comparable. Lactate level during the first 24 hours was 6.2 ± 0.7 mmol/L in the HTK group and 6.9 ± 0.4 mmol/L in the CBC group (p < 0.0001). Serial troponin measurements were lower in the HTK group (1.49 ± 0.45) compared to the CBC group (1.69 ± 0.18) at the first 72 hours postoperatively (p = 0.005). Postoperative echocardiographic assessment of RV function by means of tricuspid annular plane systolic excursion and myocardial performance index were better in the HTK group than in the CBC grpup (p < 0.05).

Conclusions

HTK cardioplegia may offer better cardiac protection to pediatric patients undergoing tetralogy of Fallot repair than our institutional standard CBC with better recovery for the hypertrophic RV.

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来源期刊

Journal of cardiothoracic and vascular anesthesia 医学-呼吸系统

CiteScore

4.80

自引率

17.90%

发文量

606

审稿时长

37 days

期刊介绍： The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.