Limited Myocardial Protective Effect of Leukocyte-depleted Blood Cardioplegia in Mitral Valve Surgery

在二尖瓣手術中使用除去白血球之含血心臟麻痺液後對心肌保護作用有限

10.29833/FJS.200810.0003

吳佳展(Chia-Chan Wu)；林子鏞(Tzu-Yu Lin)；邱冠明(Kuan-Ming Chiu)；朱樹勳(Shu-Hsun Chu)

leukocyte filter ； cardioplegia ； troponin-I

Formosan Journal of Surgery

41卷5期（2008 / 10 / 01）

203 - 208

英文

目的：白血球是心臟手術中造成再灌流傷害的原因之一。本研究的主要目的是觀察使用白血球過濾器去除含血心臟麻痺液中的白血球，是否可以減少二尖瓣手術後的心肌傷害。 方法：本研究收集了四十位進行二尖瓣手術的病人。他們被隨機分配成兩組：第一組在給予含血心臟麻痺液之前先通過白血球過濾器，第二組則沒有。在主動脈橫夾之前，及橫夾釋放後2、6、8、30小時抽血驗troponin-I。同時間記錄恢復期的其他指數。 結果：兩組病人之間的基本資料及主動脈橫夾的時間無明顯差異。加入白血球過濾器無法一致性地降低所有抽血時間點的troponin-I。拔管時間、加護病房及總住院時間在兩組間亦無明顯差異。有用白血球過濾的病人在初入加護病房時所用的dobutamine劑量有較低的傾向，但未達有效統計差異。 結論：我們的結果不支持在二尖瓣手術中常規使用白血球過濾器來過瀘含血心臟麻痺液，尤其是心室收縮力正常且主動脈橫夾時間無特別延長的病患。

Objective: Leukocytes are the main effectors to cause reperfusion injury in patients undergoing heart surgery, which may result in myocardial damage and unfavorable outcome. The aim of this study was to investigate whether leukocyte depletion by commercially available leukocyte filter could decrease myocardial injury after mitral valve surgery. Methods: Forty patients proposed to have mitral valve surgery were enrolled in this study. They were randomly allocated to one of these two groups: group 1 had leukocyte filter and group 2 did not have leukocyte filter during the blood cardioplegia delivery. Blood samples were drawn from the arterial line before aortic clamping and 2, 6, 18, 30 hours after removal of the cross clamp for troponin-I level determination. The recovery profiles were also recorded. Results: The demographic data and crossclamp time were comparable in both groups. The leukocyte filter did not cause consistent changes in troponin-I level at every check point. The intubation time, intensive care unit stay and hospital stay were also similar. The patients with the leukocyte filter seemed to have less dopamine dose at ICU admission, but without statistical significance. Conclusion: Our data did not support the routine use of a commercially available leukocyte depleting filter for blood cardioplegia delivery in mitral valve surgery without low LVEF or prolonged cross-clamp time.