PDF(Pubmed)
Abstract：
Background and Objectives: The relationship between histidine-tryptophan-ketoglutarate (HTK)-induced hyponatremia and brain injury in adult cardiac surgery patients is unclear. This study analyzed postoperative neurological outcomes after intraoperative HTK cardioplegia infusion. Materials and Methods: A prospective cohort study was conducted on 60 adult patients who underwent cardiac surgery with cardiopulmonary bypass. Of these patients, 13 and 47 received HTK infusion and conventional hyperkalemic cardioplegia, respectively. The patients\' baseline characteristics, intraoperative data, brain injury markers, Mini-Mental State Examination (MMSE) scores, and quantitative electroencephalography (qEEG) data were collected. Electrolyte changes during cardiopulmonary bypass, the degree of hyponatremia, and any associated brain insults were evaluated. Results: The HTK group presented with acute hyponatremia during cardiopulmonary bypass, which was intraoperatively corrected through ultrafiltration and normal saline administration. Postoperative sodium levels were higher in the HTK group than in the conventional cardioplegia group. The change in neuron-specific enolase levels after cardiopulmonary bypass was significantly higher in the HTK group (p = 0.043). The changes showed no significant differences using case-control matching. qEEG analysis revealed a significant increase in relative delta power in the HTK group on postoperative day (POD) 7 (p = 0.018); however, no significant changes were noted on POD 60. The MMSE scores were not significantly different between the two groups on POD 7 and POD 60. Conclusions: HTK-induced acute hyponatremia and rapid correction with normal saline during adult cardiac surgeries were associated with a potential short-term but not long-term neurological impact. Further studies are required to determine the necessity of correction for HTK-induced hyponatremia.
摘要：
背景与目的：组氨酸-色氨酸-酮戊二酸（HTK）诱导的低钠血症与成人心脏手术患者脑损伤的关系尚不清楚。本研究分析了术中输注HTK心脏停搏液后的神经系统转归。材料和方法：对60例接受体外循环心脏手术的成年患者进行了前瞻性队列研究。在这些病人中,13和47接受了HTK输注和常规高钾血症性心脏停搏液，分别。患者的基线特征，术中数据,脑损伤标记物,简易精神状态检查(MMSE)成绩,并收集了定量脑电图（qEEG）数据。体外循环期间的电解质变化，低钠血症的程度,和任何相关的脑损伤进行了评估。结果：HTK组在体外循环期间出现急性低钠血症，术中通过超滤和生理盐水给药进行校正。HTK组术后钠水平高于常规心脏停搏组。体外循环后，HTK组的神经元特异性烯醇化酶水平变化明显更高（p=0.043）。使用病例对照匹配，变化没有显着差异。qEEG分析显示HTK组在术后第7天(POD)显著增加(p=0.018);POD60无明显变化.两组在POD7和POD60上的MMSE评分没有显着差异。结论：在成人心脏手术中，HTK引起的急性低钠血症和生理盐水的快速矫正与潜在的短期但不是长期的神经系统影响有关。需要进一步的研究来确定纠正HTK引起的低钠血症的必要性。
