风湿性心脏病患者心脏瓣膜置换术中体温对心脏复跳及心肌损伤的影响  

Effects of body temperature during heart valve replacement on heart re-beat and myocardial injury in patients with rheumatic heart disease

作　　者：姬金兰[1] 李秋菊 李佳弟 韩艳艳[1] JI Jin-lan;LI Qiu-ju;LI Jia-di;HAN Yan-yan(Cardiovascular Surgery,First Affliated Hospital of Henan University of Science and Technology,Luoyang,Henan 471003,Chin)

机构地区：[1]河南科技大学第一附属医院心血管外科,河南洛阳471003

出　　处：《中国卫生检验杂志》2023年第8期954-957,共4页Chinese Journal of Health Laboratory Technology

基　　金：河南省联合共建项目(2018020286)。

摘　　要：目的探讨心脏瓣膜置换术中体温对风湿性心脏病患者心脏复跳及心肌损伤的影响。方法选取2019年6月—2022年6月在本院确诊的96例风湿性心脏病行心脏瓣膜置换术患者,采用随机数字表法分为A、B、C 3组,每组各32例。A、B、C 3组患者分别对应体外循环液体加温仪设定的温度为33.5℃、35.5℃、37.5℃。比较3组患者术中各时间点[T_(0)(入室后5 min,泵注麻醉药物之前)、T_(1)(注射完负荷剂量后即刻)、T_(2)(气管插管后1 min)、T_(3)(劈胸骨后1 min)、T_(4)(主动脉阻断前即刻)、T_(5)(停机后30 min)、T_(6)(手术结束时)]平均动脉压(MAP)、心率(HR)水平以及心脏复跳情况;比较2组T_(0)、T_(5)、T_(6)、术后6 h(T7)、术后24 h(T_(8))时的肌酸激酶同工酶(CK-MB)、肌钙蛋白Ⅰ(cTnⅠ)水平;记录术后并发症发生率。结果在T_(1)、T_(2)、T_(3)时间点,C组MAP、HR均低于A组(P<0.05),且与B组MAP、HR水平差异无统计学意义(P>0.05)。T7和T_(8)时,C组患者CK-MB、cTnⅠ水平低于A组和B组(P<0.05);C组患者心脏复跳时间低于A组和B组(P<0.05);C组心脏自动复跳率高于A组和B组(P<0.05)。结论风湿性心脏病患者心脏瓣膜置换术中,温度设置为37.5℃能有效地维持瓣膜置换术时血流动力学稳定,提高心脏复跳率,减轻其心肌损伤。Objective This paper aims to explore the effects of body temperature during heart valve replacement on heart re-beat and myocardial injury in patients with rheumatic heart disease(RHD).Methods A total of 96 patients with RHD undergoing heart valve replacement in the above hospital were enrolled between June 2019 and June 2022.According to random number table method,they were divided into group A,group B and group C,with 32 cases in each group.And the temperature of the three groups was respectively set at 33.5℃,35.5℃,and 37.5℃in cardiopulmonary bypass liquid warming device.The levels of mean arterial pressure(MAP)and heart rate(HR),and heart re-beat at different time points during surgery were compared among the three groups[T0(5 min after entering the room,before pumping anesthetics drugs),T^(1)(immediately after injecting load dose),T^(2)(1 min after tracheal intubation),T^(4)(1 min after sternum spltting),T^(4)(immediately before aortic occlusion),T^(5)(30 min after shutdown),T^(6)(at the end of the surgery)]were compared;the levels of creatine kinase isoenzyme(CK-MB)and cardiac troponin I(cTnl)at T0,T^(5),T^(6),6 h after surgery(T^(7))and 24 h after surgery(T8)were compared.The incidence of postoperative complications was recorded.Results At T^(1),T^(2)and T^(3),MAP and HR in group C were lower than those in group A(P<0.05),but there was no statistical significance on the difference between group C and group B(P>0.05).At T,and Ts,levels of CK-MB and cTnl in group C were lower than those in group A and group B(P<0.05).The heart re-beat time in group C was shorter than that in group A and group B(P<0.05).The automatic heart re-beat rate in group C was higher than that in group A and group B(P<0.05).Conclusion During heart valve replacement in RHD patients,setting the temperature to 37.5 C can effectively maintain stable hemodynamics during valve replacement,increase heart re-beat rate and reduce myocardial damage.

关 键 词：风湿性心脏病 心脏瓣膜置换术 体温 心脏复跳 心肌损伤 

分 类 号：R541.2[医药卫生—心血管疾病]