国际麻醉学与复苏杂志   2014, Issue (1): 0-0
    
主动脉内球囊反搏用于重症心脏瓣膜病瓣膜置换术的效果
李中云, 陆健君, 杨焱焰, 文建乾, 牙耀, 刘文伟, 甘立书1()
1.南宁市第三人民医院
The effects of intra-aortic balloon counterpulsation inplanted preoperatively in patients with severe valvular heart disease
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摘要：

【摘要】 目的 评价主动脉内球囊反搏(intra-aortic balloon counterpulsation,IABP)用于重症心脏瓣膜病瓣膜置换术的效果。方法 拟行心脏手术的重症瓣膜病患者60例，采用随机数字表法，将患者随机分为两组，每组30例：研究组（A组)患者术前置入IABP备心脏复跳后行反搏，对照组（B组)不用IABP。于转机前（T2)、转机后60min（T3)、停机时（T4)、术后6h（T5)、12h（T6)、24h（T7)、48h（T8)时记录两组患者尿量及分别抽取静脉血测定血清磷酸肌酸激酶(CK)、肌酸激酶同功酶(CK-MB)、心肌肌钙蛋白I(cTnI)、血乳酸（Lac)的值。记录两组患者围术期临床资料。结果 与B组比较，两组各时点MAP、HR、CVP、LAP、尿量、手术时间、ECC时间、心脏复跳率比较差异无统计学意义(P＞0.05)；A组T5～T8时CK (623±45)、(432±34)、(339±40)、(252±21)u/L，CK-MB(172±37)、(146±29)、(122±29)、(78±21) u/L，cTnI(48.8±7.7)、(41.3±8.3)、(30.8±6.4)、(20.2±6.0) μg/L，Lac(3.12±0.79)、(2.10±0.86)、(1.53±0.74)、(1.19±0.48) mmol/L均明显降低(P<0.05)，术后多巴胺(7.2±2.1) μg•kg﹣1•min﹣1、多巴酚丁胺(7.2±2.1) μg•kg﹣1•min﹣1用量明显减少 (P<0.05)，且肾上腺素使用例数(0/30)显著减少(P<0.01)，呼吸机辅助呼吸时间(18.3±7.6)h、ICU停留时间(4.8±1.2)d、术后住院时间(13.8±4.8)d均缩短(P<0.05)，早期死亡率(0/30)显著下降(P<0.01)。结论 IABP用于重症心脏瓣膜病瓣膜置换术，在心脏复跳后行IABP支持，对术后心肌有一定的保护作用，可以降低死亡率，提高手术的成功率。
关键词： 关键词：重症；心脏瓣膜病；主动脉内球囊反搏；
Abstract:

[Abstract] Objective To evaluate the effects of intra-aortic balloon pump (IABP) inplanted preoperatively in patients with severe valvular heart disease who need counterpulsation cardiac resuscitation.Method The 60 patients with severe valvular heart disease who need surgical treatment were randomly divided into treated groups(n=30) and control group(n=30) by a randomized single-blind method. The patients in treated group were inplanted with IABP preoperatively and cardiac resuscitated after operation.The patients in control group were note inplanted with IABP and cardiac resuscitated without it. The hemodynamic parameters in different time(time before anesthesia, T0; 5 minints after induction of anesthesia, T1;before CPB,T2; 60min after CPB,T3; the termination of CPB,T4; 6h after surgery,T5; 12h after surgery,T6; 24h after surgery, T7; 48h after surgery,T8.) were recorded.During of T2~ T8, urine volume was recorded and venous blood was extracted for quantifying the serum creatine kinase (CK), the creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), blood lactate (Lac).Other parameters were also recorded. Results Parameters of MAP, HR, CVP, LAP, urine output, operation time, ECC, cardiac resuscitation rate difference in treated group and control group were not significant different (P> 0.05) at each time point. The plasma comcentration of CK in treated group at T5 ~ T8(623±45)、(432±34)、(339±40)and(252±21)u/L and CK-MB(172±37)、(146±29)、(122±29)and(78±21) u/L and cTnI (48.8±7.7)、(41.3±8.3)、(30.8±6.4)and(20.2±6.0) μg/L and Lac (3.12±0.79)、(2.10±0.86)、(1.53±0.74)and(1.19±0.48) mmol/L were significantly lower than control group (P<0.05), the consumption of dopamine(7.2±2.1) μg•kg﹣1•min﹣1 and dobutamine(7.2±2.1) μg•kg﹣1•min﹣1 after surgery were significantly reduced (P<0.05),and the cases applied of adrenaline(0/30) were also significant reduced (P <0.01).The other parameters in treated group, such as time of ventilation time(18.3±7.6)h, time of ICU stayed(4.8±1.2)d, hospitalization time after surgery (13.8±4.8)d and mortality(0/30) were lower than that in control group(P<0.05). Conclusion Preoperative inplantation of IABP in patients with severe valvular heart disease during surgery of valve replacement could protect the myocardium,increased the survival of patients and decreased the cost of hospitalization.
Key words: 【Key words】: severe; valvular heart disease; intra-aortic balloon counterpulsation