亚低温血液净化技术在瓣膜病术后心源性休克治疗中的疗效及风险评估  

Effects and risks of hypothermia during blood purification in the treatment of postoperative cardiogenic shock in valvular heart diseases

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：《中华危重病急救医学》2015年第12期975-979,共5页Chinese Critical Care Medicine

基　　金：湖北省武汉市医药卫临床科研基金项目（WX13C48）

摘　　要：目的观察通过血液净化实施亚低温治疗技术在心脏瓣膜病术后心源性休克患者治疗中的效果以及风险。方法采用非盲法的前瞻性随机对照试验（RCT）研究方法，选择2011年1月至2014年12月武汉亚洲心脏病医院重症加强治疗病房（ICU）收治的择期行心脏瓣膜置换术后出现心源性休克的患者，按随机数字表和信封隐匿法分为常温连续性血液净化（CBP）组和亚低温CBP组。两组患者均给予连续性静脉-静脉血液滤过（CVVH），常温CBP组维持血温在36．5～37．3℃，亚低温CBP组则控制血温在34．0～35．0℃。观察两组治疗前和治疗后1、2、3d的心排血指数（CI）、氧供／氧耗比值（DO2/VO2）、急性生理学号漫性健康状况评分系统Ⅲ（APACHEⅢ）评分、多器官功能障碍综合征（MODS）评分；记录患者ICU住院时间、机械通气时间、CBP时间和ICU病死率以及并发症发生率。结果最终完成试验者共95例，其中常温CBP组47例，亚低温CBP组48例；两组患者人组时性别、年龄、术前心功能、心胸比以及瓣膜置换类型差异均无统计学意义。与治疗前比较：常温CBP组治疗后1、2、3dCI、DO2／VO2比值、APACHEⅢ和MODS评分差异均无统计学意义（均P〉0．05）；而亚低温CBP组治疗后1dDO2／VO2比值即明显好转（2．5±0．7比1．8±0．4，P〈0．05），治疗后3dCI（mL·s-1·m-2：50．01±8．34比31．67±11．67）、APACHEⅢ评分（分：50．6±6．2比77．5±5．5）、MODS评分（分：6．0±1．5比9．3±3．4）均明显改善（均P〈0．05）；且亚低温CBP组治疗后1d起DO2／VO2比值即明显高于常温CBP组（2．5±0．7比1．8±0．4，P〈0．05），治疗后2d起CI（mL·s-1·m-2：38．34±10．00比35．01±6．67）、APACHEHI评分（分：68．9±7．1比81．2±7．3）、MODS评分（分：8．9±2．7比10．6±2．4）即较常温CBP组明显改善（均P〈0．05）。在临床结局方面，与常Objective To implement hypothermia during blood purification to investigate its effect and risk in the treatment of postoperative cardiogenic shock in valvular heart disease. Methods A non-blinded prospective randomized controlled trial （RCT） was conducted. Patients with valvular heart disease suffering from postoperative cardiogenic shock admitted to intensive care unit （ICU） of Wuhan Asian Heart Hospital from January 2011 to December 2014 were enrolled, and they were randomly divided into normothermic continuous blood purification （CBP） group （NT group ） and hypothermia CBP group （HT group ） according to random number table and envelope enclosed method. The patients in both groups were given continuous renal replacement therapy （CVVH）, the blood temperature in NT group was remained at 36.5-37.3 ℃ , and it was controlled at 34.0-35.0 ℃ in HT group. The data were collectedbefore and 1, 2, 3 days after treatment, including cardiac index （CI）, the oxygen supply/oxygen consumption ratio （DO2/VO2）, acute physiology and chronic health evaluation Ⅲ （APACHE Ⅲ ） score, multiple organ dysfunction （MODS） score. The length of ICU stay, duration of mechanical ventilation, duration of CBP, ICU mortality and the incidence of complication were recorded. Results A total of 95 patients were enrolled, with 47 patients in NT group, and 48 in HT group. There was no significant difference in gender, age, preoperative cardiac function, cardiothoracic ratio and type of valve replacement between two groups. Compared with those before treatment, no significant difference was found in CI, DO2/VO2 ratio, APACHE Ⅲ score, MODS score on 1, 2, 3 days after treatment in NT group （all P 〉 0.05）. But in HT group, DO2/VO2 ratio was significantly improved on 1 day after treatment （2.5 ± 0.7 vs. 1.8 ± 0.4, P 〈 0.05 ）, CI （mL·s-1·m-2：50.01 ± 8.34 vs. 31.67 ± 11.67 ）, APACHE Ⅲ score （ 50.6±6.2 vs. 77.5 ± 5.5 ）, and MODS score （ 6.0 ± 1.5 vs. 9.3 ± 3.4 ） were signif

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：R654.2[医药卫生—外科学] R459.7[医药卫生—临床医学]