二尖瓣与主动脉瓣病变手术电解质及相关体液因子变化的对比研究

Study of electrolytes and neurohormonal factors on mitral and aortic valvular operations

目的深入探讨二尖瓣与主动脉瓣病变瓣膜置换手术前后的不同特点和处理方法。方法选择二尖瓣狭窄并瓣膜关闭不全(MS+MI)38例(组1)、主动脉瓣狭窄并关闭不全(AS+AI)33例(组2)瓣膜置换术患者,分7个时间点测定机体电解质含量和血浆醛固酮(ALD)、儿茶酚胺(CA)水平。结果组1心肌钾、镁含量术前很低,ALD水平术前已升高,术后更高,与尿排泄钾、镁的高峰期相同;各阶段尿排泄钾、镁总量组1显著升高;组2 CA水平术前已升高,术后更高。结论二尖瓣病变术前应长期、足量补钾、补镁,才能达到心肌细胞内所需水平;主动脉瓣病变手术后以减轻心脏后负荷为主。

Objective To explore the differences between the treatment of mitral and aortic valvular pre-and-post operation. Methods Thirty-eight cases （Groupl） of mitral valvular replacement（MVR） and 33 cases （Group2） of aortic valvular replacement （AVR） were enrolled in this study. The electrolytes, aldosterone （ALl）） and catecholamine（CA） were observed and calculated at seven time-points during the perioperative period. Results Myocardial intracellar potassium and magnesium were awfully low before MVR, and ALl） was high before MVR and higher within 6-24 hours after MVR, which relatd with the urine excretion of potassium and magnesium. CA level was high before AVR and higher within 6-24 hours after AVR. ALD levels and urine excretion of potassium and magnesium were higher, and CA levels and dosage of vasodilators were lower in groupl than in Group2 at every time-points. Conclusions Only by long-term and enough supplement of potassium and magnesium, can their myocardial intracellar levels be up to the need before MVR. ACEI, ARB and ALD antagonists should be used before and after MVR. The cardiac after-load should be strongely reduced by vasodilators after AVR.