RU2320351C2 - Cardioplegic solution for intraoperation protection of myocardium - Google Patents

Abstract

FIELD: medicine, chemical-pharmaceutical industry, pharmacy.

SUBSTANCE: invention relates to cardiosurgery and can be used in operations on heart. Invention proposes a cardioplegic solution for intraoperation protection of myocardium containing the following components, ml: 5% KCl solution, 11-14; 5% NaHCO₃ solution, 4-6; 25% MgSO₄ solution, 1-2; 15% mannitol solution, 12-15; 40% glucose solution, 0.5-2; 10% calcium gluconate solution, 1-2, and 0.9% NaCl solution up to 100 ml Prepared solution is mixed with autoblood in the ratio 1:4. The claimed invention allows decreasing dose of inotropic support in post-operation period and to reduce possibility of negative results after operation on heart.

EFFECT: valuable medicinal properties of solution.

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Description

The invention relates to the field of surgery, in particular to cardiac surgery, and can be used for heart surgery.

Known cardioplegic solution (CRC) for intraoperative myocardial protection, which is used when conducting pharmacological cold crystalloid cardioplegia (FHKP), proposed in 1981 by B.A. Konstantinov. (Konstantinov B.A. Physiological and clinical foundations of surgical cardiology. - L., 1981.)

The disadvantages of this CRC are the lack of blood as the basis for cardioplegia, low ion content, acidic environment and low osmolarity, which led to an imbalance, a change in the energy potential of the cardiomyocyte, the development of myocardial edema, and ultimately the development of intraoperative myocardial infarction, the need to use high doses of inotropic support and a long postoperative period.

The purpose of the invention is to prevent the development of postoperative complications associated with inadequate myocardial protection during heart surgery and the reduction of the postoperative period.

The goal is achieved by the fact that within 10-15 minutes immediately before the operation, a cardioplegic solution is prepared for intraoperative protection of the myocardium, it includes autologous blood in proportion to the crystalloid component 4: 1 and official solutions, it is prepared within 10-15 minutes immediately before the operation, contains, ml: 5% KCl - 50, 5% NaHCO ₃ - 20, 10% Ca gluconate - 5, 25% MgSO ₄ - 5, 40% glucose - 2, 15% beckon - 50, 0.9% NaCl - 350 , the pH of the solution is 7.83, the osmolarity is 328.8 mOsm / l, cooled to 10-15 ° C and injected antiterrograde into the coronary vessels.

The method is implemented as follows.

1. 10-15 minutes before surgery in the preoperative preparing crystalloid component of the CRC of the following composition:

No. The components of the solution, ml Content Content, mol / L one KCl 5% solution fifty K ⁺ - 33.25 2 NaHCO ₃ 5% solution twenty Na ⁺ - 134 3 Ca gluconate 10% solution 5 Ca ⁺⁺ - 2.34 four MgSO ₄ 25% solution 5 Mg ⁺⁺ - 16.65 5 Mannitol 15% solution fifty Cl - 195 6 Glucose 40% solution 2 Glucose - 10.2 7 NaCl 0.9% solution 350 8 pH 7.83 9 Osmolarity, mOsm / l 328.8

2. During the operation, blood is drawn by the pump from the cardiotome reservoir of the heart-lung machine (AIC), then it is mixed with the crystalloid component using a tee connector (the flow is regulated by the pump segment), the resulting mixture of blood and crystalloid is fed into a heat exchanger, and then into cardioplegic cannulas . The ratio of the performance of the pump segments for blood supply and crystalloid is set as 4: 1.

3. The introduction of crystalloid cardioplegic solution was carried out anti-retrograde under the control of pressure in the cardioplegic line (110-130 mm Hg with antegrade, 60-80 mm Hg with retrograde injection), when persistent asystole was achieved, the pressure in the line was reduced in an average of 20 mm Hg

4. To exclude the damaging effect of deep hypothermia, the temperature of the injected solution was 10-15 ° C. The volume of crystalloid solution according to cardioplegia sessions: 1 session - 200 ml, 2 session - 100 ml, 3 and further - 75 ml each.

The proposed cardioplegic solution based on autologous blood was used for heart surgery in 30 patients. The use of this solution for intraoperative myocardial protection compared to the previous solution leads to:

1. To reduce the incidence of fibrillation at the stage of induction of cardioplegia 1.2 times.

2. Reducing the duration of sessions KP 2.3 times.

3. A decrease of 4.1 times the volume of the injected crystalloid component of the cardioplegic solution.

4. Reducing the amount of blood components used in the postoperative period.

5. Reducing the need for inotropic stimulation to correct the syndrome of small cardiac output after surgery.

6. To reduce the incidence of intraoperative myocardial infarction and postoperative acute heart failure.

7. The possibility of a full return to the circuit of the ECC apparatus, without creating excessive hemodilution.

8. The absence of the need for long-term storage, which means that it does not require specially trained personnel, sophisticated equipment for the preparation and sterilization of scarce drugs.

The use of blood as the basis of CRC leads to the effective delivery of oxygen and energy substrates, reducing the risk of reperfusion complications, the natural buffering of cardioplegic solution and antioxidant protection.

Claims (1)

Cardioplegic solution for intraoperative myocardial protection, consisting of a crystalloid component containing potassium, sodium, magnesium and calcium ions, characterized in that it contains 5% KCl solution 11-14 ml 5% NaHCO ₃ solution 4-6 ml 25% MgSO ₄ 1-2 ml 15% mannitol 12-15 ml 40% glucose 0.5-2 ml 10% Ca gluconate solution 1-2 ml 0.9% NaCl up to 100 ml the resulting solution is mixed with autoblood in a ratio of 1: 4.