风心病患者瓣膜置换术后肺动脉压变化及其与肺氧合的相关性  

Changes of pulmonary artery pressure and its correlation with pulmonary oxygenation in patients with rheumatic heart disease after valve replacement.

作　　者：肖宗位[1] 谢飞 马辰 XIAO Zong-wei;XIE Fei;MA Chen(Department of Cardiothoracic Surgery,Chengdu Second People's Hospital,Chengdu 610017,Sichuan,CHINA)

机构地区：[1]成都市第二人民医院胸心外科,四川成都610017

出　　处：《海南医学》2020年第20期2635-2639,共5页Hainan Medical Journal

基　　金：四川省医学会科研课题(编号:S18085)。

摘　　要：目的了解风心病患者围术期肺动脉压的变化,并探讨其与患者术后肺氧合的相关性。方法收集成都市第二人民医院2019年2月至2020年2月55例风心病患者,根据术毕时肺动脉压值分为肺动脉高压组(高压组)24例和肺动脉压正常组(正常组)31例,两组患者均行二尖瓣置换和/或三尖瓣成形术。在手术前(T1)、术毕(T2)、术后24 h(T3)、术后72 h(T4)4个时点测量肺动脉压值,同时抽血检查4个时点的血气和白细胞介素-6(IL-6)。结果高压组和正常组患者的体外循环时间[(178.00±57.29)min vs(146.03±38.08)min]、阻断时间[117.50(83.75,158.50)min vs 91.00(68.00,134.00)]、呼吸机辅助时间[24.00(18.00,36.50)h vs 18.00(15.00,21.00)h]比较,高压组明显长于正常组,差异均有统计学意义(P<0.05);T1时点,高压组和正常组患者的肺动脉压分别为(37.55±10.43)mmHg和(33.35±8.55)mmHg,差异无统计学意义(P>0.05),但T2时点[(33.50±3.85)mmHg vs(26.32±2.18)mmHg]、T3时点[(46.68±8.89)mmHg vs(36.00±5.83)mmHg]、T4时点[(34.55±6.05)mmHg vs(29.77±4.01)mmHg]高压组患者的肺动脉压值均高于正常组,差异均有统计学意义(P<0.05);T1时点,高压组和正常组患者的氧合指数(OI)分别为418.75±56.39和407.84±62.35,两组比较差异无统计学意义(P>0.05),但高压组和正常组患者的OI值在T2时点[(348.40±55.28)vs(398.91±76.63)]、T3时点[(230.14±39.07)vs(282.52±46.56)]和T4时点[(292.33±45.55)vs(350.01±43.99)]比较,高压组明显低于正常组,差异均有统计学意义(P<0.05);术前肺动脉压与OI无相关关系,术后3个时点肺动脉压与OI间呈负相关关系;T1时点,高压组和正常组患者的IL-6水平分别为[7.32(5.03,9.33)pg/mL vs 7.32(5.16,9.60)pg/mL],差异无统计学意义(P>0.05),但高压组和正常组患者的IL-6水平在T2时点[90.64(52.98,135.49)pg/mL vs 50.97(32.52,90.03)pg/mL]、T3时点[186.57(165.65,221.98)pg/mL vs 127.90(88.70,165.40)pg/mL]和T4时点[62.84(47.25,81.00)pg/mL vs 35.00(21.66,71.00)pObjective To investigate perioperative changes of pulmonary arterial pressure and its correlation with postoperative pulmonary oxygenation in patients with rheumatic heart disease.Methods Fifty-five patients with rheumatic heart disease were collected in Chengdu Second People's Hospital from February 2019 to February 2020.They were divided into the pulmonary hypertension group(n=24)and the normal pulmonary artery pressure group(n=31)according to the pulmonary artery pressure at the end of the operation,which underwent mitral valve replacement and/or tricuspid valvuloplasty.Pulmonary artery pressure was measured before surgery,at the end of surgery,24 hours after surgery,and 72 hours after surgery,and blood gas and IL-6 were taken simultaneously at the 4 time points.Results The cardiopulmonary bypass time,aortic cross-clamping time,and ventilator assistance time of the pulmonary hypertension group were respectively(178.00±57.29)min,117.50(83.75,158.50)min,24.00(18.00,36.50)h,significantly longer than(146.03±38.08)min,91.00(68.00,134.00)min,18.00(15.00,21.00)h in the normal pulmonary artery pressure group(P<0.05).Pulmonary artery pressure showed no statistically significant difference between the two groups at T1:(37.55±10.43)mmHg vs(33.35±8.55)mmHg,P>0.05;while the pulmonary artery pressure in the pulmonary hypertension group were significantly higher than those in the normal pulmonary artery pressure group at T2,T3,T4(P<0.05):T2,(33.50±3.85)mmHg vs(26.32±2.18)mmHg;T3,(46.68±8.89)mmHg vs(36.00±5.83)mmHg;T4,(34.55±6.05)mmHg vs(29.77±4.01)mmHg.The oxygenation index(OI)value of the two groups showed no statistically significant deference at T1(P>0.05):(418.75±56.39)vs(407.84±62.35),while OI in the pulmonary hypertension group were significantly higher than those in the normal pulmonary artery pressure group at T2,T3,T4(P<0.05):T2,(348.40±55.28)vs(398.91±76.63);T3,(230.14±39.07)vs(282.52±46.56);T4,(292.33±45.55)vs(350.01±43.99).There was no correlation between preoperative pulmonary artery pressure a

关 键 词：肺动脉高压 肺氧合 瓣膜置换术 全身炎症反应综合 白细胞介素-6 肺血管损伤 

分 类 号：R541.2[医药卫生—心血管疾病]