康斯特液与威斯康星大学液保存供体心脏的对比研究

摘要

目的：回顾性分析康斯特（ HTK）液与威斯康星大学（ UW）液在供体心脏冷缺血保存期间的临床对比效果。方法纳入阜外医院2004年6月至2014年5月期间心脏移植手术436例，其中使用UW液保存供体心脏为100例，使用HTK液保存供体心脏的为336例，比较两组相关临床资料，评价两种心脏保存液的保存效果。结果261例供体心脏保存时间少于360 min，设为A组，其中应用UW液保存26例，应用HTK液保存235例；175例供心保存时间大于等于360 min，设为B组，其中应用UW液保存74例，应用HTK液保存101例。在A、B两组中，UW液冷缺血保存时间均较HTK液保存时间长[（309．85±40．82） vs （219．12±73．99） min，（ P＜0．05）；（458．07±80．57） vs （427．58±54．49）min，（ P＜0．05）]。两组组内对比指标，包括术后血清肌钙蛋白I（cTnI）值、自动复跳率、机械辅助通气时间、体外膜肺氧合（ECMO）、主动脉内球囊反搏（IABP）应用情况均无统计学差异。在长时间保存供心的B组中，应用UW液术后ICU停留时间较短（3．78±3．51） vs （7．03±8．24）d，（ P＜0．05）。结论在心脏移植中，应用UW 液保存供体心脏可耐受更久的冷缺血时间，且其ICU 时间缩短，较于HTK 液更具有优越性。%Objective To summarize retrospective data of heart allografts preserved in University of Wisconsin ( UW) or histi⁃dine-tryptophan-ketoglutarate ( HTK) solutions. Methods From June 2004 to May 2014, 436 heart transplants were performed in our institute. The heart allografts were preserved using UW solution ( n=100) orHTK solution ( n=336) . The clinical outcomesof the two heart preservation solutionswere compared. Results A total of 261 heart allografts had an ischemia time less than 360 minutes, re⁃garded as group A, including 26 hearts in UW and 235 hearts in HTK. There were 175 heart allografts whose ischemia time was longer than or equal to 360 minutes, regarded as group B, including 74 hearts in UW and 101 hearts in HTK. Heart allografts preserved in UW took longer time than HTK in both groups (309.85±40.82) vs (219.12±73.99) min, ( P<0.05);(458.07±80.57) vs (427.58± 54.49) min, ( P<0.05) . There was no statistical difference in terms of post-operative cTnI, as well as the auto-rebeat rate, ventila⁃tion, extracorporeal membrane oxygenation and intraaortic balloon pump. In group B, UW solution was associated with shorter length of staying in ICU (3.78±3.51) vs (7.03±8.24) days, P<0.05). Conclusion This study suggests that heart allograft preserved in UW solution has better clinical outcomes compared with HTK solution in heart transplantation.