Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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A Comparison of the Effects of Histidine-tryptophan-ketoglutarate Solution versus Cold Blood Cardioplegic Solution on Myocardial Protection in Mitral Valve Surgery

승모판막수술 시 히스티딘를 함유한 결정성 심정지액(Histidine-tryptophan-ketoglutarate Solution)과 저온 혈성 심정지액이 심근기능 보존에 미치는 영향 비교

  • Choi, Yong-Seon (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Bang, Sou-Ouk (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Chang, Byung-Chul (Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Lee, Sak (Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine) ;
  • Park, Chol-Hee (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Kwak, Young-Lan (Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine)
  • 최용선 (연세대학교 의과대학 마취통증의학교실) ;
  • 방서욱 (연세대학교 의과대학 마취통증의학교실) ;
  • 장병철 (연세대학교 의과대학 흉부외과학교실, 심혈관연구소) ;
  • 이삭 (연세대학교 의과대학 흉부외과학교실, 심혈관연구소) ;
  • 박철희 (연세대학교 의과대학 마취통증의학교실) ;
  • 곽영란 (연세대학교 의과대학 흉부외과학교실, 심혈관연구소)
  • Published : 2007.06.05
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Abstract

Background: Ischemia-reperfusion injury related to unsuccessful myocardial protection affects postoperative ventricular function and mortality during open-heart surgery. We prospectively compared the effects of administration of histidine-tryptophan-ketoglutarate (HTK) solution and cold blood cardioplegia (CBC) on myocardial protection and clinical outcome in patients undergoing mitral valve surgery. Material and Method: Seventy patients with mitral regurgitation (MR) undergoing mitral valve surgery were randomly divided into the HTK group (n=31) and the CBC group (n=31 ): eight patients were excluded. Perioperative hemodynamics, cardiac medications, pacing, postoperative outcomes and complications were recorded during the hospital stay. All patients received follow-up for at least 6 months postoperatively for morbidity and mortality. Resuか: There were no significant differences in the hemodynamics between the groups during the study period, except for the mean pulmonary artery pressure (MPAP), PCWP and CVP that were lower in the HTK group at 15 min after weaning of CBP. There were no differences for inotropic support and pacing during the 12 hrs postoperatively between the groups. CK-MB values on day 1 and day 2 were $77{\pm}54$ and $41{\pm}23$ for the HTK group and $70{\pm}69$ and $44{\pm}34$ for the CBC group, respectively (p=NS). Postoperative clinical outcomes were similar in both groups for at least 6 months during the follow-up period. Conclusion: These results suggest that the use of HTK solution is as safe as cold blood cardioplegia in terms of myocardial protection.

배경: 개심술 시 불충분한 심근 보호로 인한 허혈과 재관류 손상은 술 후 심실 기능과 예후에 영향을 미친다. 본 저자들은 승모판막 수술에서 HTK 용액과 냉혈 혈성 심정지액이 심근 보호와 임상 결과에 미치는 영향을 전향적으로 비교 분석하였다. 대상 뜻 방법: 승모판막폐쇄부전으로 승모판막수술을 받는 70명의 환자 중 8명의 환자를 제외한 31명에서 HTK 용액을(HTK군), 31명에서 냉혈 혈성 심정지액을(CBC군) 사용하였다. 수술 중과 후에 환자의 혈역학, 심혈관계 약물과 심장박동조율기의 사용, 임상경과 및 합병증을 관찰하였다. 모든 환자에서 최소 6개월 이상 사망률과 이환율을 추적 관찰하였다. 결과: 혈역학적 변수는 평균폐동맥압, 중심정맥압과 폐모세혈관쐐기압이 체외순환으로부터 이탈 후 시기에 HTK군에서 유의하게 낮았던 점을 제외하고는 모든 시기에서 군 간 차이가 없었다. 심근수축제와 심장박동조율기의 사용은 모든 시기에서 군 간 차이가 없었다. 수술 후 1일과 2일째 CK-MB 수치는 HTK군에서 $77{\pm}54,\;41{\pm}23$ (ng/mL)로 CBC군의 $70{\pm}69,\;44{\pm}34$ (ng/mL)와 유의한 차이가 없었다. 6개월 이상의 추적관찰 중 임상경과는 비슷하였다. 결론: 이상의 결과에서 HTK 용액은 냉혈 혈성 심정지액과 비슷한 심근 보호효과를 가짐을 확인할 수 있었다.

Keywords

References

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