急性感染性心内膜炎患者体外循环下心脏瓣膜置换时机的临床价值  

To explore the clinical value of different timing of heart valve replacement in patients withAIE under cardiopulmonary bypass

作　　者：叶海峰[1] 王书秀[2] YE Haifeng;WANG Shuxiu(Department of Cardiovascular Surgery,Handan Central Hospital,Handan Hebei 056004,China)

机构地区：[1]邯郸市中心医院心血管外科,河北邯郸056004 [2]邯郸市第一医院肿瘤二科,河北邯郸056002

出　　处：《中国急救复苏与灾害医学杂志》2024年第12期1548-1552,1591,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2021年度河北省医学科学研究课题计划(编号:20211921)。

摘　　要：目的探究急性感染性心内膜炎(AIE)患者体外循环下心脏瓣膜置换术(CVR)时机的临床价值。方法选取2020年1月—2022年1月邯郸市中心医院98例AIE患者,根据治疗时间分为两组,早期组于AIE确诊1周内进行体外循环下CVR,延期组于AIE确诊1周后进行体外循环下CVR。观察两组手术治疗情况、经食管超声心动图(TEE)相关指标[中心静脉压(CVP)、心排血指数(CI)、左心室射血分数(LVEF)]、凝血纤溶系统指标[凝血酶原时间(PT)、抗凝血酶Ⅲ(AT-Ⅲ)、纤维蛋白(FIB)、部分凝血活酶时间(APTT)、凝血酶时间(TT)、D-二聚体(D-D)]、炎症因子[白细胞介素(IL)-18、IL-1β]、外周血单核细胞焦亡相关蛋白[NOD样受体蛋白3(NLRP3)、半胱氨酸天冬酶-1(Caspase-1)、消皮素D(GSDMD)]、住院期间术后并发症发生率、术后1年病死率。结果早期组术后住院时间较延期组短(t=4.443,P<0.05);术后3、7 d两组CVP较术前下降,CI及LVEF较术前升高(P<0.05);术后3、7 d两组FIB、D-D较术前下降,早期组FIB、D-D低于延期组(P<0.05);术后3 d两组IL-18、IL-1β较术前升高,术后7 d两组IL-18、IL-1β较术后3 d下降(P<0.05);术后3 d两组NLRP3、Caspase-1、GSDMD蛋白表达较术前升高,术后7 d两组NLRP3、Caspase-1、GSDMD蛋白表达较术后3 d下降(P<0.05);早期组住院期间术后并发症发生率低于延期组,术后1年病死率低于延期组(P<0.05)。结论AIE患者行体外循环下CVR可减轻患者术后炎症反应,促进术后心功能、凝血纤溶系统恢复,但早期进行手术效果较好,可减少患者术后并发症发生率,降低病死率。Objective To study the timing of cardiac valve replacement(CVR)in patients with acute infective endocarditis(AIE)under cardiopulmonary bypass(CPB)based on coagulation and fibrinolysis system.Methods Ninety eight patients with AIE who were admitted in Handan Central Hospital from January 2020 to January 2022 conducted on this study.All patients were divided into two groups based upon the timing of CVR after diagnosis.49cases underwent CVR under CPB within one week as the early group;another 49 cases underwent CVR under CPB over one week as the delayed group.Operative treatment,transesophageal echocardiography(TEE)related indexes[central venous pressure(CVP),cardiac discharge index(CI),left ventricular ejection fraction(LVEF)],thrombin fibrinolysis system indexes[PT),antithrombinⅢ(ATⅢ),fibrin(FIB),partial thrombin time(APTT)were observed and compared between the two groups.The following items were also recorded for all patients including thrombin time(TT),D-dimer(D-D)],inflammatory cytokines[interleukin-18,IL-1β],peripheral blood monocyte pyrogen related proteins[Nod-like receptor protein 3(NLRP3),cysteine aspartase 1(Caspase-1),dermatin D(GSDMD)],postoperative complications during hospitalization incidence and mortality one year after operation.Results CVP,FIB and D-D were decreased;CI and LVEF were increased in both groups(t=4.443,P<0.05)at 3 and 7 days after surgery.FIB and D-D ofthe early group were lower than those of the delayed group(P<0.05).The levels of IL-18 and IL-1βin the two groups were higher at 3 days than before,and decreased at 7 days as compared with 3 days after surgery(P<0.05).The expressions of NLRP3,Caspase-1 and GSDMD in two groups were increased by day3 and decreased at 7 day;but no significantly difference in those as compared with before surgery(P>0.05).The hospital stay of the early group was shorter than that of the delayed group(P<0.05).The 1-year postoperative mortality in the early group was lower than that in the delayed group(P<0.05).Conclusion CVR under CPB in patients with A

关 键 词：急性感染性心内膜炎 凝血纤溶系统 体外循环 心脏瓣膜置换术 炎症反应 

分 类 号：R542.41[医药卫生—心血管疾病]