吗啡联合高压氧预处理对体外循环心脏瓣膜置换术后患者相关指标的影响
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篇名: 吗啡联合高压氧预处理对体外循环心脏瓣膜置换术后患者相关指标的影响
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摘要: 目的:探讨吗啡联合高压氧预处理对体外循环心脏瓣膜置换术后患者相关指标的影响。方法:129例拟行体外循环心脏瓣膜置换术患者随机分为常规组(43例)、单独组(43例)和联合组(43例)。常规组患者于术前30 min肌内注射阿托品、苯巴比妥;单独组患者于体外循环心脏瓣膜置换术中缓慢注射盐酸吗啡注射液0.2 mg/kg;联合组患者在单独组用药的基础上于术前加用医用高压氧舱,术前3 d每日1次,连用3 d。各组均以咪达唑仑、芬太尼和派库溴铵进行麻醉诱导。观察各组患者手术前后心率、收缩压、舒张压、脉压、左室射血分数(LVEF)、心功能指标[左房内径(LAD)、舒张期室间隔厚度(IVST)、左室舒张末期内径(LVDD)、左室后壁厚度(PWT)、左心室心肌重量(LVM)、左心室心肌重量指数(LVMI)]、T淋巴细胞亚群水平(CD3+、CD4+、CD8+、CD4+/CD8+、Th1、Th2、Th1/Th2、Treg/CD4+、Th17/CD4+)、免疫功能指标[免疫球蛋白A(IgA)、IgM、IgG、补体C3、补体C4]及不良反应发生情况。结果:术后,联合组患者LVEF显著高于同组术前及常规组、单独组,IVST、LVDD均显著低于同组术前及常规组、单独组,差异均有统计学意义(P<0.05);单独组、联合组患者CD8+、Th1、Th2、Th1/Th2、Th17/CD4+、补体C3水平均显著低于同组术前及常规组,且联合组低于单独组,CD4+、CD4+/CD8+、Treg/CD4+均显著高于同组术前及常规组,且联合组高于单独组,差异均有统计学意义(P<0.05)。各组患者用药期间均未见明显不良反应发生。结论:吗啡联合高压氧预处理可改善体外循环心脏瓣膜置换术后患者的心功能和T淋巴细胞水平,降低补体C3水平,且安全性较好。
ABSTRACT: OBJECTIVE: To explore the effects of morphine combined with hyperbaric oxygen preconditioning on the related indicators in patients after heart value replacement in cardiopulmonary bypass. METHODS: 129 patients with heart value replacement in cardiopulmonary bypass were randomly divided into normal group (43 cases), single group (43 cases) and combined group (43 cases). Normal group intramuscularly injected atropine and phenobarbital 30 min before surgery, then conducted heart value replacement in cardiopulmonary bypass. Single group slowly injected Morphine hydrochloride injection 0.2 mg/kg when taking heart value replacement in cardiopulmonary bypass. On the basis of single group, combined group was additionally given medical hyperbaric oxygen chamber, once a day in the 3 day before surgery, and anesthesia induction was performed with midazolam, fentanyl and captopril in all groups. The heart, systolic blood pressure, diastolic blood pressure, pulse pressure, LVEF, cardiac function indexes(LAD, IVST, LVDD, PWT, LVM, LVMI), T lymphocyte subsets (CD3+,CD4+,CD8+,CD4+/CD8+,Th1,Th2,Th1/Th2,Treg/CD4+,Th17/CD4+),IgA,IgM,IgG,complement C3,C4 levels before and after treatment, and the incidence of adverse reactions in all groups were observed. RESULTS: After surgery, LVEF in combined group was significantly higher than before, normal group and single group, LVDD and IVST were significantly lower than before, normal group and single group (P<0.05); CD8+,Th1, Th2, Th1/Th2, Th17/CD4+, complement C3 levels in single group and combined group were significantly lower than before and normal group, and combined group was lower than single group, CD4+,CD4+/CD8+,Treg/CD4+ were significantly higher than before and normal group, and combined group was higher than single group(P<0.05). There were no obvious adverse  reactions during treatment. CONCLUSIONS: Morphine combined with hyperbaric oxygen preconditioning can improve the cardiac functions and T lymphocyte subset levels in patients after heart value replacement in cardiopulmonary bypass, reduce complement C3 content, with good safety.
期刊: 2016年第27卷第36期
作者: 罗世官,陈宏明,谭荣邦,李日著
AUTHORS: LUO Shiguan,CHEN Hongming,TAN Rongbang,LI Rizhu
关键字: 吗啡;高压氧;心脏瓣膜置换术;心功能;T淋巴细胞;免疫功能
KEYWORDS: Morphine; Hyperbaric oxygen; Heart value replacement; Cardiac function; T lymphocyte; Immune function
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