亚低温血液净化技术在心脏瓣膜病术后心源性休克治疗中的应用  

作　　者：肖红艳[1] 许卫江[1] 刘彬[1] 李颖[1] 危宇[1] 任海波[1] 

机构地区：[1]武汉亚洲心脏病医院ICU,湖北武汉430022

出　　处：《中国急救医学》2015年第9期836-839,共4页Chinese Journal of Critical Care Medicine

基　　金：武汉市卫计委临床医学科研基金资助项目（WX13C48）

摘　　要：目的通过血液净化（continuousb lood purification，CBP）实施亚低温治疗，观察该技术在心脏瓣膜病术后心源性休克治疗中的作用。方法将符合人选标准的95例患者随机分为常温（normothermic，NT）治疗组（NT组）47例和亚低温（mildhypothermia，HT）治疗组（HT组）48例，观察两组入选时及入选后1、2、3d心脏指数（cardiacindex，CI）、氧供（oxygen delivery，D02）与氧耗（oxygen consumption，V02）比值、APACHEⅢ评分、多器官功能障碍综合征（multipleorgan dysfunction syndorme，MODS）评分等临床指标，以及两组最终住ICU时间、机械通气时间、CBP时间、感染发生率、心律失常、出血量及病死率，将以上指标进行对比研究。结果两组入选时各项观察指标差异无统计学意义（P〉0．05）；与人选时比较，NT组治疗后1、2、3dCI、DO2／V02比值、APACHEIU评分、MODS评分差异无统计学意义（P〉0．05），HT组治疗后1dDO：／VO：比值明显好转（P〈0．05），但CI、APACHEⅢ评分、MODS评分差异无统计学意义（P〉0．05），治疗后3dCI、APACHEⅢ评分、MODS评分差异有统计学意义（P〈0．05）；HT组总的住ICU时间、机械通气时间、CBP时间、死亡率均小于NT组（P〈0．05），术后总的感染例数、室性心律失常例数、出血量两组比较差异无统计学意义（P〉0．05）。结论亚低温CBP能有效地改善心脏瓣膜病术后心源性休克患者早期的氧供需失衡，延缓病情进展，改善预后，安全有效。Objective The mild hypothermia therapy had been used in blood purification , and to observe its protective effects on postoperative cardiac shock in valvular heart disease .Methods Ninety-five patients were randomly divided into the normothermic blood purification group ( NT group, n=47) and mild hypothermia blood purification group (HT group, n=48).Cardiac index (CI), the ratio of oxygen delivery ( DO2 ) and oxygen consumption ( VO2 ) , score of the APACHEⅢ and multiple organ dysfunction syndrome (MODS), ICU stays, mechanical ventilation time, CBP time, incidence of infection, arrhythmia, blood loss and mortality within two groups at the 0, 1, 2, and 3 days were recorded and compared .Results There was no significant difference when compared within two groups at the day 0 (P>0.05).Compared with the day 0, those clinic monitoring data of CI, DO2/VO2 ratio, score of the APACHEⅢand MODS in NT group had no significant difference at each days ( P>0.05);DO2/VO2 ratio had been improved significantly in HT group at the day 1 (P<0.05), the other indexs had no significant difference ( P >0.05 ); at the day 3, all clinic monitoring data had significant differences (P<0.05).ICU stays, mechanical ventilation time, CBP time and the mortality in HT group were less than those in NT group (P<0.05), but the cases of infection, arrhythmia and blood loss between two groups had no significant difference ( P>0.05).Conclusion Hypothermia blood purification can safely and effectively improve the early imbalance of oxygen supply , postpone the progress of disease and improve the prognosis for postoperative cardiac shock patients with valvular heart disease.

关 键 词：心脏瓣膜病术后 心源性休克 亚低温 血液净化 

分 类 号：R651.15[医药卫生—外科学]