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体外循环下心脏瓣膜置换术患者隆德排气对血流动力学参数和炎症介质的影响

Lund exhaust on hemodynamic parameters and inflammatory mediators in patients undergoing cardiac valve replacement under cardiopulmonary bypass.

作者信息

Zhu Jihong, Zhang Weimin, Shen Guoying, Yu Xin, Guo Jige, Zhong Taidi

机构信息

Department of Anesthesiology, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China.

Heart Center, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China.

出版信息

Exp Ther Med. 2018 Sep;16(3):1747-1752. doi: 10.3892/etm.2018.6354. Epub 2018 Jun 26.

Abstract

The effect of Lund exhaust technique on hemodynamics and inflammatory mediators in patients undergoing cardiac valve replacement under cardiopulmonary bypass was evaluated. A total of 60 patients with heart disease undergoing elective heart valve replacement under elective cardiopulmonary bypass were randomly divided into Lund exhaust group (group A) and control group (group B), with 30 patients in each group. Group A underwent Lund exhaust during cardiopulmonary bypass, while group B was identical to group A except for not using the Lund exhaust technique during cardiopulmonary bypass. The hemodynamic parameters at different time-points showed that the indexes of MAP, PASP, CO, CI, PCWP, CVP and SVR in T, T, T and T moments between group A and group B were statistically significant (p<0.05). There was no statistical significance in IL-6, IL-8, IL-10, TNF-α and TIMP-1 between group A and group B patients at the T moment (p>0.05). The levels of IL-6, IL-8, IL-10, TNF-α and TIMP-1 in group B patients at T, T, T and T moments were statistically significant compared with those in group A (p<0.05). The IL-6, IL-8, TNF-α indexes of group B patients were statistically significant at the T moment compared with those in group A (p<0.05). The IL-10 and TIMP-1 of two groups were not statistically significant at the T moment. The operating time, CPB time, aortic clamp time, intraoperative blood loss, postoperative tube time, ICU stay time, hospital stay time and pulmonary infection of patients in group A were significantly less than those in group B. In conclusion, Lund exhaust technology can significantly reduce the fluctuation of hemodynamics, decrease the expression of inflammatory factors, improve lung function, and is conducive to the rehabilitation of patients.

摘要

评估了隆德排气技术对体外循环下心脏瓣膜置换患者血流动力学和炎症介质的影响。选取60例择期在体外循环下行心脏瓣膜置换术的心脏病患者,随机分为隆德排气组(A组)和对照组(B组),每组30例。A组在体外循环期间采用隆德排气,而B组除在体外循环期间不使用隆德排气技术外,其他与A组相同。不同时间点的血流动力学参数显示,A组和B组在T、T、T和T时刻的MAP、PASP、CO、CI、PCWP、CVP和SVR指标差异有统计学意义(p<0.05)。A组和B组患者在T时刻的IL-6、IL-8、IL-10、TNF-α和TIMP-1差异无统计学意义(p>0.05)。B组患者在T、T、T和T时刻的IL-6、IL-8、IL-10、TNF-α和TIMP-1水平与A组相比差异有统计学意义(p<0.05)。B组患者在T时刻的IL-6、IL-8、TNF-α指标与A组相比差异有统计学意义(p<0.05)。两组在T时刻的IL-10和TIMP-1差异无统计学意义。A组患者的手术时间、体外循环时间、主动脉阻断时间、术中出血量、术后带管时间、ICU停留时间、住院时间和肺部感染均明显少于B组。综上所述,隆德排气技术可显著降低血流动力学波动,减少炎症因子表达,改善肺功能,有利于患者康复。

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