血液灌流器对体外循环下心脏瓣膜置换患者术后谵妄的影响  

The efficacy of hemoperfusion cartridge procedure on postoperative delirium in patients undergoing cardiac valve replacement under cardiopulmonary bypass

作　　者：闫莉 孙斌[2] 周美艳 张妍[2] 陈娇 汪美如 王立伟 Yan Li;Sun Bin;Zhou Meiyan;Zhang Yan;Chen Jiao;Wang Meiru;Wang Liwei(Xuzhou Clinical School of Xuzhou Medical University,Department of Anesthesiology,Xuzhou Central Hospital,Jiangsu Xuzhou 221004,China)

机构地区：[1]徐州医科大学徐州临床学院,徐州221000 [2]徐州市中心医院麻醉科

出　　处：《中国体外循环杂志》2024年第6期473-477,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(82071903);徐州市科技计划项目(KC22174)。

摘　　要：目的评估血液灌流器预防心脏瓣膜置换患者术后谵妄(POD)的安全性与有效性。方法本研究为随机对照研究,选择2023年11月至2024年4月在体外循环下行开胸心脏瓣膜置换患者60例,采用随机数字表法分为血液灌流器组(n=30)和对照组(n=30)。在血液灌流器组中,HA380血液灌流器并联到体外循环管路中,灌注时间与体外循环时间相同。对照组未使用HA380血液灌流器。结果两组患者一般资料无统计学差异(P>0.05)。对比两组术后资料发现,血液灌流器组患者POD发生率低于对照组(3.3%vs.26.7%,P=0.026),血液灌流器组术后1 d白介素-6、白介素-10、血浆S100β蛋白浓度低于对照组。术后两组患者在切口不愈合、肺部感染、机械通气时间、使用主动脉内球囊反搏、ICU停留时间以及30 d生存率等方面无统计学意义(P>0.05)。结论血液灌流器可有效降低心脏瓣膜置换患者POD的发生率。Objective To evaluate the safety and efficacy of a hemoperfusion device in preventing postoperative delirium(POD)in patients undergoing cardiac valve replacement.Methods This randomized controlled trial included 60 patients scheduled for open-heart valve replacement under cardiopulmonary bypass(CPB)from November 2023 to April 2024.Patients were randomly assigned to the hemoperfusion group(n=30)and the control group(n=30)using a random number table method.In the hemoperfusion group,the HA380 hemoperfusion device was incorporated into the CPB circuit,with perfusion time matching the CPB duration.The control group did not use the HA380 hemoperfusion device.Results There were no statistically significant differences in the general characteristics between the two groups(P>0.05).Postoperative data comparison revealed that the incidence of POD was lower in the hemoperfusion group compared to the control group(3.3%vs.26.7%,P=0.026).Additionally,levels of IL-6,IL-10,and plasma S100βprotein concentrations on postoperative day 1 were lower in the hemoperfusion group.There were no statistically significant differences between the two groups in terms of wound healing,pulmonary infection,mechanical ventilation duration,use of intra-aortic balloon pump,ICU stay duration,and 30-day survival rate(P>0.05).Conclusion The hemoperfusion device effectively reduces the incidence of POD in patients undergoing cardiac valve replacement.

关 键 词：心脏手术 瓣膜置换 血液灌流 体外循环 术后谵妄 炎性因子 

分 类 号：R65[医药卫生—外科学]