风湿性心脏病围手术期最大呼气流量的变化及应用糖皮质激素对其的影响  

Effects of glucocorticoid on the changes of PEF undergoing rheumatic valve replacement

作　　者：王强[1] 彭超[1] 胥飚[2] 陈应凯 刘昱兵 蒋迎九[1] 

机构地区：[1]重庆医科大学附属第一医院胸心外科,重庆400016 [2]重庆医科大学附属第一医院临床检验科

出　　处：《临床心血管病杂志》2016年第8期826-830,共5页Journal of Clinical Cardiology

基　　金：重庆市科技攻关计划项目(No:cctc2012gg-yyjs10055)

摘　　要：目的：探讨风湿性心脏病（风心病）瓣膜替换术围手术期最大呼气流量（peak expiratory flow,PEF）的变化及糖皮质激素的应用对其影响。方法：180例风心病患者,按入院先后顺序随机分为干预组（A）、对照组（B）,每组90例,术前A、B两组组内分别按NYHA心功能分级分别为Ⅱ级、Ⅲ级、Ⅳ级分组,按年龄段小于40岁,40~60岁,60岁以上3个年龄段分组;A、B两组患者体外循环术中均予甲级强的松龙1 000mg,A组术后第1、2、3天,每天给予地塞米松10mg静脉注射,B组术后前3d不予以激素;应用酶联免疫法分别测定术前1天、术后第1、3、5、7天早7点血清皮质醇浓度,用科卡PEF-3峰速仪测定各对应的下午4点PEF值,比较在激素干预下不同心功能级别及不同年龄分层患者中围手术期PEF动态变化,观察患者的康复情况。结果：A、B两组围手术期血清皮质醇未见明显差别;A、B两组在术前及术后第3天PEF值之间未见明显差异（P〉0.05）,术后第5、7天干预组较对照组PEF明显增高（P〈0.05）;不论心功能如何分级,干预组术后第5、7天PEF均高于对照组;不同年龄分组之间,60岁以下的患者围手术期使用激素可增加术后第5、7天PEF值,两组间差异有统计学意义（P〈0.05）,60岁及其以上的患者,激素的应用可以增加PEF值,但PEF值两组间无明显差异（P〉0.05）。结论：风心病体外循术瓣膜替换术后小剂量糖皮质激素的应用并未加重皮质醇分泌节律的紊乱;风心病患者围手术期激素的应用可改善肺通气功能,提高PEF值。Objective：To investigate the dynamic changes of the PEF（peak expiratory flow）and explore effects of the glucocorticoid on it＇s changes in the patients during rheumatic valve replacement.Method：The 180 patients with rheumatic heart disease undergoing valve replacement were randomly allocated into two groups：group A（the study group,n=90）and group B（the control group,n=90）.Each group was divided into 3subgroups（II,III,IV grade cardiac function）according to NYHA heart function classification and was divided into 3subgroups（less than 40 years,40~60years,over 60 years old）by the age.Two groups were both respectively given 1000 mg methylprednisolone during extracorporeal circulation,while only the group A were intravenously injected with10 mg glucocorticoid on the first three postoperative days and the group B without any additional medication intervention.The enzyme-linked immunosorbent assay（ELISA）was taken to detect the serum cortisol concentration at 7in the morning and the PEF（peak expiratory flow,PEF）was measured at 4O＇clock in the afternoon by Keka PEF-3detector during the first day before operation,the first postoperative day,the third postoperative day,the fifth postoperative day and the seventh postoperative day.Then we investigated the dynamic changes of PEF value and the patients＇ recovery.Result：The serum cortisol concentration between group A and group B has no significant difference（P〉0.05）;The PEF of the first preoperative day and the third postoperative day seemed no difference（P〉0.05）,however the PEF of group A on the fifth and the seventh postoperative day showed remarkably higher than group B（P〈0.05）.The PEF in patients with II,III and IV grade cardiac function before operation in group A were distinctly higher than the group B（P〈0.05）.The PEF of the patients under 60 years in group A was significantly higher than that in group B on the fifth and seventh postoperative day（P〈0.05）.The mean value of PEF in the patients over 60 year

关 键 词：风湿性心脏病 体外循环 糖皮质激素 皮质醇 最大呼气流量 

分 类 号：R541.2[医药卫生—心血管疾病]