Fang Jihui, Xu Ming, Liu Bin, Wang Bo, Ren Haibo, Yang Haitao, Dong Yaling, Song Laichun, Xiao Hongyan
Department of Cardiac Surgery.
Department of Intensive Care Unit, Wuhan Asia Heart Hospital, Wuhan.
Medicine (Baltimore). 2020 Mar;99(13):e19476. doi: 10.1097/MD.0000000000019476.
To observe the effect of sub-hypothermia (HT) blood purification technique in the treatment of cardiac shock after heart valve disease.The patients were randomly divided into normothermic (NT) continuous blood purification (CBP) group (NT group) and HT CBP group (HT group). Observe the cardiac index (CI), the oxygen delivery (DO2) and oxygen consumption (VO2) ratio, Acute Physiology and Chronic Health Evaluation III(APACHE III) score, multiple organ dysfunction syndrome (MODS) score, dynamic monitoring of electrocardiograph, blood loss with or without muscle tremors, intensive care unit stay, mechanical ventilation time, CBP time, and the cases of infection and mortality at 0 day, 1 day, 2 day, 3 day; all above indicators were compared between 2 groups.Ninety-five patients were randomly assigned into HT group (48 cases) and NT group (47 cases); there were no significant differences between the 2 groups for age, gender, pre-operative cardiac function, cardiothoracic ratio, and type of valve replacement (P > .05). There were no significant differences among the 1 day, 2 day, 3 day after recruited for CI, DO2/VO2 ratio, APACHE III score, MODS score (P > .05). But in HT group, DO2/VO2 ratio had been significantly improved after treatment for 1 day (2.5 ± 0.7 vs 1.8 ± 0.4, P = .024), and CI (3.0 ± 0.5 vs 1.9 ± 0.7, P = .004), APACHE III score (50.6 ± 6.2 vs 77.5 ± 5.5 P = .022), MODS score (6.0 ± 1.5 vs 9.3 ± 3.4, P = .013) also had been significantly improved after treatment for 3 days. In clinical outcomes, there were no significant differences between 2 groups for blood loss (617.0 ± 60.7 ml vs 550.9 ± 85.2 ml, P = .203), infection ratio (54.17% vs 53.19%, P = .341), the incidence of ventricular arrhythmia (31.25% vs 36.17%, P = .237), and muscle tremors (14.58% vs 8.51%, P = .346), while there were significant differences between 2 groups for intensive care unit stay (6.9 ± 3.4 days vs 12.5 ± 3.5 days, P = .017,), mechanical ventilation time (4.2 ± 1.3 days vs 7.5 ± 2.7 days, P = .034,), CBP time (4.6 ± 1.4 days vs 10.5 ± 4.0 days, P = .019), mortality (12.50% vs 23.40%, P = .024). But the incidence of bradycardia in HT group was much higher than the NT group (29.16% vs 14.89%, P = .029).HT blood purification is a safer and more effective treatment than NT blood purification for patients who suffered from cardiac shock after valve surgery.
观察亚低温血液净化技术治疗心脏瓣膜病术后心源性休克的效果。将患者随机分为常温连续血液净化（CBP）组（NT组）和亚低温CBP组（HT组）。观察心脏指数（CI）、氧输送（DO2）与氧消耗（VO2）比值、急性生理与慢性健康状况评分系统Ⅲ（APACHEⅢ）评分、多器官功能障碍综合征（MODS）评分，动态监测心电图、有无肌肉震颤的失血量、重症监护病房停留时间、机械通气时间、CBP时间，以及0天、1天、2天、3天时的感染情况和死亡率；比较两组上述所有指标。95例患者随机分为HT组（48例）和NT组（47例）；两组在年龄、性别、术前心功能、心胸比和瓣膜置换类型方面差异无统计学意义（P＞0.05）。入组后1天、2天、3天的CI、DO2/VO2比值、APACHEⅢ评分、MODS评分差异无统计学意义（P＞0.05）。但HT组治疗1天后DO2/VO2比值显著改善（2.5±0.7比1.8±0.4，P = 0.024），治疗3天后CI（3.0±0.5比1.9±0.7，P = 0.004）、APACHEⅢ评分（50.6±6.2比77.5±5.5，P = 0.022）、MODS评分（6.0±1.5比9.3±3.4，P = 0.013）也显著改善。临床结局方面，两组在失血量（617.0±60.7ml比550.9±85.2ml，P = 0.203）、感染率（54.17%比53.19%，P = 0.341）、室性心律失常发生率（31.25%比36.17%，P = 0.237）和肌肉震颤（14.58%比8.51%，P = 0.346）方面差异无统计学意义，而两组在重症监护病房停留时间（6.9±3.4天比12.5±3.5天，P = 0.017）、机械通气时间（4.2±1.3天比7.5±2.7天，P = 0.034）、CBP时间（4.6±1.4天比10.5±4.0天，P = 0.019）、死亡率（12.50%比23.40%，P = 0.024）方面差异有统计学意义。但HT组心动过缓发生率高于NT组（29.16%比14.89%，P = 0.029）。对于瓣膜手术后发生心源性休克的患者，亚低温血液净化治疗比常温血液净化更安全、有效。
