Objective: To explore the safety and myocardial protection efficacy of del Nido cardioplegia in adult cardiac and major vascular surgery with long aortic cross-clamp (ACC) time. Methods: A total of 2 536 patients who underwent adult cardiac and major vascular surgery with ACC time>90 min at Beijing Anzhen Hospital from March 2018 to March 2023 were collected. The patients were divided into two groups according to the type of cardioplegia solution: the del Nido cardioplegia solution group (DC group) and the cold blood cardioplegia solution group (BC group). Preoperative baseline data of the patients (age, gender, comorbidities, ejection fraction, etc) were adjusted using propensity score matching (PSM). Cardiopulmonary bypass (CPB) time, ACC time, total amount of cardioplegia solution, in-hospital mortality rate, length of intensive care unit (ICU) stay, mechanical ventilation time, postoperative complications, left ventricular ejection fraction, and troponin levels were compared between the two groups. Results: After PSM, a total of 306 patients were included, including 223 males and 83 females, with a mean age of (52.0±12.3) years. There were 153 cases in the DC group and 153 cases in the BC group. Compared with the DC group, the cross-clamp time was longer [109(100, 150) min vs 102(91, 133) min, P<0.001], the rate of return to spontaneous rhythm was lower [51.6% (79/153) vs 86.9%(133/153), P<0.001], and intraoperative peak glucose was higher [12.6 (6.5, 15.9) mmol/L vs 10.1 (8.5, 12.4) mmol/L, P=0.005] in the BC group. In addition, perioperative mortality [4.6% (7/153) vs 3.3% (5/153), P=0.132], stroke[3.9% (6/153) vs 3.3% (5/153), P=0.759], renal insufficiency [3.3% (5/153) vs 6.5% (10/153), P=0.186], atrial fibrillation [4.6% (7/153) vs 2.6% (4/153), P=0.652] and low cardiac output syndrome [3.9% (6/153) vs 4.6% (7/153), P=0.716] did not differ between the two groups. Compared with BC group, DC group had lower level of high sensitivity troponin (hsTnI) [1.2 (0.8, 1.8) μg/L vs 1.3 (0.9, 2.3) μg/L, P=0.030] and creatine kinase isoenzyme (CK-MB) [31.0 (20.0, 48.9) μg/L vs 37.0 (24.0, 58.9) μg/L, P=0.011] at 24 h postoperatively, and shorter length of ICU stay [35.6 (19.8, 60.5) h vs 42.6 (21.9, 83.6) h, P=0.015] and mechanical ventilation time [20.5 (15.5, 41.0) h vs 31.5 (17.1, 56.0) h, P=0.012]. Subgroup analysis showed that in the 120-180 minute subgroup, patients in the DC group had a shorter cross-clamp time [132 (124, 135) min vs 136 (124, 138) min, P<0.001], while levels of hsTnI [1.6 (1.1, 2.0) μg/L vs 1.4 (1.0, 2.6) μg/L, P=0.030] and CK-MB [38.8 (23.5, 55.5) μg/L vs 37.0 (24.5, 62.3) μg/L, P=0.011] were higher than those in the BC group. Conclusions: In adult cardiac and major vascular surgery with ACC times>90 min, comparable myocardial protection is observed with the use of DC compared with BC. Additional advantages in glycemic control, return to spontaneous rhythm, and improved surgical procedures make DN an attractive alternative for myocardial protection in adult cardiac surgery.
目的： 探讨del Nido心脏停搏液对成人心脏大血管手术中长时间主动脉阻断患者的安全性和心肌保护效果。 方法： 回顾性收集2018年3月至2023年3月在北京安贞医院行体外循环下成人心脏大血管手术且主动脉阻断时间>90 min的患者，根据术中使用停搏液种类分为两组，del Nido心脏停搏液组（DC组）和冷含血心脏停搏液组（BC组）。收集患者临床资料，通过倾向性评分匹配校正患者年龄、性别、合并症、左心室射血分数等术前基线资料。对两组患者术中转流时间、阻断时间、停搏液总量、灌注次数、术后30 d死亡率、术后重症监护病房（ICU）时间、气管插管时间、术后并发症、左心室射血分数、肌钙蛋白等资料进行比较。 结果： 通过倾向性评分匹配，最终共纳入306例患者，男223例，女83例，年龄（52.0±12.3）岁；DC组153例，BC组153例。与DC组相比，BC组的主动脉阻断时间［M（Q1，Q3）］更长［109（100，150）min比102（91，133）min，P<0.001］，自动复跳率更低［51.6%（79/153）比86.9%（133/153），P<0.001］，且BC组术中血糖峰值更高［12.6（6.5，15.9）mmol/L比10.1（8.5，12.4）mmol/L，P=0.005］。DC和BC组围手术期死亡率［4.6%（7/153）比3.3%（5/153），P=0.132］、脑卒中［3.9%（6/153）比3.3%（5/153），P=0.759］、肾功能不全［3.3%（5/153）比6.5%（10/153），P=0.186］、心房颤动［4.6%（7/153）比2.6%（4/153），P=0.652］和低心排血量综合征［3.9%（6/153）比4.6%（7/153），P=0.716］发生率差异均无统计学意义。DC组患者术后24 h高敏肌钙蛋白［1.2（0.8，1.8）μg/L比1.3（0.9，2.3）μg/L，P=0.030］及肌酸激酶同工酶［31.0（20.0，48.9）μg/L比37.0（24.0，58.9）μg/L，P=0.011］水平较BC组更低，住ICU时间［35.6（19.8，60.5）h比42.6（21.9，83.6）h，P=0.015］和机械通气时间［20.5（15.5，41.0）比31.5（17.1，56.0），P=0.012］均较BC组患者更短。亚组分析显示，在120~180 min亚组中，DC组患者主动脉阻断时间更短［132（124，135）min比136（124，138）min，P<0.001］，而术后24 h高敏肌钙蛋白［1.6（1.1，2.0）μg/L比1.4（1.0，2.6）μg/L，P=0.030］及肌酸激酶同工酶［38.8（23.5，55.5）μg/L比37.0（24.5，62.3）μg/L，P=0.011］水平较BC组患者更高。 结论： 在主动脉阻断时间>90 min的成人心脏大血管手术中，使用DC安全有效，可提供与BC相似的心肌保护效果，且在血糖控制、自动复跳等方面表现出优势。.