亚低温治疗心脏外科术后多器官功能障碍的病例对照研究  

The effect of mild hypothermia on multiple organ dysfunction system post-cardiac surgery: a case control study

作　　者：赵晓琪[1] 谷天祥[1] 修宗谊[1] 喻磊[1] 钱程[1] 

机构地区：[1]中国医科大学附属第一医院心脏外科,沈阳110001

出　　处：《中国胸心血管外科临床杂志》2017年第3期201-205,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金："十二五"国家科技支撑项目(2011BAI11B19)

摘　　要：目的观察亚低温治疗对心脏外科术后多器官功能障碍患者的疗效,总结其安全性及治疗价值,为临床合理应用提供理论基础。方法回顾性分析我院2010年5月至2014年6月行心脏外科手术后出现多器官功能障碍90例患者的临床资料,其中男57例、女33例,平均年龄(61±6)岁,使用亚低温治疗的患者(HT组)58例,未使用亚低温治疗的患者(NT组)32例,比较两组患者临床效果。结果 90例患者中死亡18例(20.0%),其中HT组死亡8例患者(13.8%),NT组死亡10例(31.2%,P<0.05)。其中HT组中9例患者应用主动脉内球囊反搏(IABP)(15.5%),NT组12例患者应用IABP(37.5%,P<0.05)。HT组氧分压(PO2)、静脉血氧饱和度(Sv O2)和血乳酸(Lac)较NT组明显改善(P<0.05),HT组血压在亚低温治疗开始时较NT组低,但在36 h后较NT组明显升高(P<0.05),HT组血小板(PLT)在36 h时较NT组明显改善。两组患者凝血酶原时间(PT)和部分凝血酶原时间(APTT)差异无统计学意义。在低温治疗36 h时,HT组患者的血小板(PLT)较NT组患者明显改善,两组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血清肌肝(Cr)均有所改善,但HT组较NT组改善明显(P<0.05)。结论亚低温治疗可以有效改善心脏外科术后多器官功能衰竭患者器官功能,延缓器官功能衰竭速度,从而为进一步治疗赢得时间,是一种安全有效的治疗手段。Objective To summarize the effect of mild hypothermia on post-cardiac surgery patients with multiple organ dysfunction system（MODS）. Methods We retrospectively analyzed the clinical data of 90 patients with MODS after cardiac surgery under cardiopulmonary bypass（CPB） from May 2010 through June 2014 in our hospital. There were 57 males and 33 females at 61±6 years. The patients were divided into two groups including a NT group （without pre-hypothermia treatment,n=32） and a HT group（with pre-hypothermia treatment,n=58）. Results Of the 90 patients, totally 18 patients died, 8 patients （13.8%） in the HT group, 10 patients （31.2%） in the NT group with a statistical difference （P〈0.05）. In the NT group, 12 patients （37.5%） were treated by intra-aortic balloon pump （IABP）, and 9 patients （15.5%） in the HT group with a statistical difference between the two groups （P〈0.05）. The patients＇ heart rate （HR） decreased significantly after the application of hypothermia. The HR of difference between the two groups at 36 h was significant （P〈0.05）. The mean aortic pressure （MAP） in the HT group was lower than that of the NT group significantly at 0 h, because we used sedation and muscular relaxation agent. But the MAP in the HT group was significantly higher than that of the NT group after hypothermia 36 h （P〈0.05）. In the HT group, pressure of oxygen （PO2）, mixed venous oxygen saturation （SvO2）, and lactic acid （Lac） were improved significantly compared with those of the NT group significantly （P〈0.05）. There was no statistical difference in prothrombin time （PT） or activated partial thromboplastin time （APTT） between the two groups （P〉0.05）. But there was a statistical difference in platelet （PLT） between the two groups at 36 h （P〈0.05）. The aspartate aminotransferase （AST）, alannine aminotransferase （ALT）, creatinine （Cr） were improved significantly in the HT group （P〈0.05）. Conclusion Mild hypoth

关 键 词：低温 多器官功能衰竭 心脏 

分 类 号：R654.2[医药卫生—外科学]