胰岛素-葡萄糖对体外循环下联合瓣膜置换术患者的心肌保护作用
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篇名: 胰岛素-葡萄糖对体外循环下联合瓣膜置换术患者的心肌保护作用
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摘要: 目的:探讨胰岛素-葡萄糖对体外循环下联合瓣膜置换术患者的心肌保护作用。方法: 120例在我院接受体外循环下联合瓣膜置换术治疗的患者,按照随机数字表法分为对照组(60例)和观察组(60例)。所有患者均按照常规操作进行手术,对照组患者采用4 ℃托马斯停跳液与氧合血按照1 ∶ 4(V ∶ V)混合进行心肌保护。观察组患者心肌保护方法与对照组相同,但在4 ℃托马斯停跳液中加入胰岛素注射液10 IU/L和葡萄糖注射液10 g/L。观察并比较两组患者麻醉诱导前(T0)、体外循环结束时(T1)、术后12 h(T2)、术后24 h(T3)、术后48 h(T4)、术后72 h(T5)血浆脑钠肽(BNP)、心肌肌钙蛋白Ⅰ(cTnⅠ)水平、主动脉开放后自动复跳率、T1时血管活性药物(多巴胺)使用量、术后并发症发生情况和不良反应发生情况。结果:T0时,两组患者血浆BNP、cTnⅠ水平比较,差异无统计学意义(P>0.05)。T1-5时,两组患者BNP、cTnⅠ水平显著高于T0时,差异均有统计学意义(P<0.05),且cTnⅠ水平在T4时开始降低,BNP水平在T5 h时开始降低。此外,观察组患者BNP、cTnⅠ水平在T1-5时显著低于对照组,差异均有统计学意义(P<0.05)。主动脉开放后,两组患者自动复跳率比较,差异无统计学意义(P>0.05)。观察组患者多巴胺使用量(T1时)、术后并发症总发生率显著少于对照组,差异均有统计学意义(P<0.05)。两组患者术中及术后均未见严重药物相关不良反应发生。结论:胰岛素-葡萄糖可以减轻体外循环下联合瓣膜置换术患者的心肌损害,减少血管活性药物使用量,降低术后并发症发生率,安全性亦较好。
ABSTRACT: OBJECTIVE: To investigate the protective effects of insulin-glucose on myocardium in patients receiving cardiac valve replacement under cardiopulmonary bypass. METHODS: Totally 120 patients receiving combined cardiac valve replacement under cardiopulmonary bypass were divided into control group and observation group according to random number table, with 60 cases in each group. All patients were given routine operation. Control group was given Thomas cardioplegia and oxygenated blood with a ratio of 1 ∶ 4 (V ∶ V)to protect myocardium at 4 ℃. Besides that, the observation group was additionally given Insulin injection 10 IU/L and Glucose injection 10 g/L added into Thomas cardioplegia at 4 ℃ to protect myocardium. The levels of plasma brain natriuretic peptide (BNP) and cardiac troponinⅠ(cTnⅠ)before anesthesia induction (T0), at the end of cardiopulmonary bypass (T1),12 h (T2),24 h(T3),48 h (T4), and 72 h (T5) after surgery, the rate of recovery of automatic heartbeat after opening aorta, the application of vasoactive agent (dopamine) at T1 and the occurrence of postoperative complications were observed and compared between 2 groups. RESULTS: At T0, there was no statistical significance in the levels of plasma BNP and cTnⅠ between 2 groups (P>0.05). The levels of plasma BNP and cTnⅠin 2 groups at T1-5 were significantly higher than T0, with statistical significance (P<0.05); the levels of cTnⅠ began to decrease at T4 and cTnⅠbegan to decrease at T5. However, the levels of BNP and cTnⅠwere significantly lower in observation group than in control group at T1-5, with statistical significance (P<0.05). After opening aorta, there was no statistical significance in the rate of recovery of automatic heartbeat between 2 groups (P>0.05). The dosage of dopamine (at T1) and the incidence of complications in observation group were statistically lower than control group, with statistical significance (P<0.05). No severe ADR was found in 2 groups during or after surgery. CONCLUSIONS: Insulin-glucose can alleviate myocardial damage,  reduce the dosage of vasoactive agent and the incidence of postoperative complications in patients receiving combined cardiac valve replacement under cardiopulmonary bypass with significant protective effect on myocardium with good safety.
期刊: 2017年第28卷第21期
作者: 秦建华,张雪容,马庆军,何亮,田永芳
AUTHORS: QIN Jianhua,ZHANG Xuerong,MA Qingjun,HE Liang,TIAN Yongfang
关键字: 胰岛素;体外循环;联合瓣膜置换术;心肌保护;脑钠肽;心肌肌钙蛋白Ⅰ
KEYWORDS: Insulin; Cardiopulmonary bypass; Combined cardiac valve replacement; Myocardial protection; Brain natriuretic peptide; Cardiac troponinⅠ
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