吸入用七氟烷结合治疗性沟通系统模式在心脏瓣膜置换术患者中的应用  

Inhaled Sevoflurane Combined with Therapeutic Communication System Model in Patients Undergoing Heart Valve Replacement

作　　者：张慧 周杰 潘婷 林聪 Zhang Hui;Zhou Jie;Pan Ting;Lin Cong(Department of Anesthesia and Perioperative Medicine,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院麻醉与围术期医学科,南京210029

出　　处：《成都医学院学报》2025年第1期123-127,共5页Journal of Chengdu Medical College

摘　　要：目的探讨吸入用七氟烷结合治疗性沟通系统模式对心脏瓣膜置换术(HVR)患者心肌损伤与血流动力学的影响。方法选取2021年6月至2022年10月于南京医科大学第一附属医院收治的202例HVR患者为研究对象,随机分为对照组和试验组,每组101例。两组均行HVR,对照组术中予以丙泊酚乳状注射液进行麻醉维持,试验组在对照组基础上予以吸入用七氟烷进行麻醉维持,两组术后均随访3个月,均于围手术期间给予治疗性沟通系统模式干预。比较两组血流动力学[麻醉诱导前(T1)、麻醉诱导5 min(T2)、气管插管时(T3)]、左室功能[术前(T0)、术后3个月(T7)]、心肌损伤、脑损伤[T1、主动脉开放后6 h(T4)、主动脉开放后24 h(T5)]、生命质量[T0、术后1个月(T6)、T7]及院内结局、并发症(围手术期间)等指标。结果与T1比较,两组T2、T3的心率(HR)和平均动脉压(MAP)逐渐降低,试验组较同期对照组更低(P<0.05)。与T0比较,两组T7的左室射血分数(LVEF)升高,左室舒张末期容积(LVEDV)和左室收缩末期容积(LVESV)降低(P<0.05)。与T1比较,两组T4、T5的血清心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)水平逐渐升高,试验组较同期对照组更低(P<0.05);两组血浆神经元特异性烯醇化酶(NSE)和Tau蛋白水平升高,试验组较同期对照组更低(P<0.05)。与T4比较,两组T5的血浆NSE和Tau蛋白水平降低,试验组较对照组更低(P<0.05)。与T0比较,两组T6、T7的生命质量评分逐渐升高,试验组较同期对照组更高(P<0.05)。两组院内结局、并发症比较,差异无统计学意义(P>0.05)。结论吸入用七氟烷结合治疗性沟通系统模式可明显改善HVR患者血流动力学,减轻患者心肌损伤和脑损伤,改善患者生命质量,且院内结局和安全性均良好。Objective To investigate the effects of inhaled sevoflurane combined with a therapeutic communication system model on myocardial injury and hemodynamics in patients undergoing heart valve replacement(HVR).Methods A total of 202 patients with HVR admitted to The First Affiliated Hospital with Nanjing Medical University from June 2021 to October 2022 were included and randomly divided into the control group and the experimental group,with 101 patients in each group.Both groups underwent HVR.The control group was given propofol lactic injection to maintain anesthesia during the operation,while the experimental group was given sevoflurane for anesthesia maintenance by inhalation on the basis of propofol lactic injection.Both groups were followed up for three months after the operation,and were given interventions under the model of therapeutic communication system in the perioperative period.Hemodynamics[detected before induction of anesthesia(T1),at 5 min of induction of anesthesia(T2),and at the time of tracheal intubation(T3)],left ventricular function[detected preoperatively(T0),and at 3 months postoperatively(T7)],myocardial injury,brain injury[detected at T1,6 h after aortic opening(T4),and 24 h after aortic opening(T5)],quality of life[detected at T0,1 month postoperatively(T6),and T7],in-hospital outcomes and complications(perioperative period)were compared.Results Compared with those at T1,heart rate(HR)and mean arterial pressure(MAP)at T2 and T3 gradually decreased in both groups,and were lower in the experimental group than those in the control group at the same time points(P<0.05).Compared with those at T0,left ventricular ejection fraction(LVEF)at T7 was higher while left ventricular end-diastolic volume(LVEDV)and left ventricular end-systolic volume(LVESV)were lower in both groups(P<0.05).Compared with those at T1,serum cardiac troponin I(cTnI)and creatine kinase isoenzyme(CK-MB)at T4 and T5 gradually increased in both groups,and were lower in the experimental group than those in the control group at th

关 键 词：心脏瓣膜置换术 吸入用七氟烷 治疗性沟通 血流动力学 心肌损伤 

分 类 号：R542.5[医药卫生—心血管疾病]