风湿性心脏瓣膜病围术期电解质变化的研究

The Study of Electrolytic Alterations in the Perioperative Period of the Rheumatic Heart Disease

目的对心肌细胞内、外钾、镁离子进行研究，旨在掌握电解质与心肌保护的关系及其变化规律，调整电解质的平衡，减少心肌损伤和心律失常。方法选择２７例风湿性心脏病（ｒｈｅｕｍａｔｉｃｈｅａｒｔｄｉｓｅａｓｅ，ＲＨＤ）患者和８例先天性心脏病（ｃｏｎｇｅｎｉｔａｌｈｅａｒｔｄｉｓｅａｓｅ，ＣＨＤ）患者分为ＲＨＤ组和ＣＨＤ组，在围术期测定血液、心肌细胞内和尿中钾、镁离子的含量以及血浆醛固酮水平。结果ＲＨＤ组心肌钾、镁含量术前低于ＣＨＤ组，尿排钾、镁的高峰在术后２４小时内。醛固酮水平ＲＨＤ组中二尖瓣病变患者术前就高于正常，术后２４小时达高峰。结论维持围术期钾、镁离子的平衡，可明显减少心律失常和心肌损伤的发生；现行的术前补钾量和时间不足，在加强补钾的同时，应配合补充镁；术后２４小时内。

Objective To study the myocardial intra and extracellular potassium and magnesium in order to clarify the relationship between electrolytes and myocardial protection and their changing rules so as to regulate electrolytic balances effectively and diminish myocardial injury and arryhthmias. Methods Twenty seven patients with rheumatic heart disease(RHD) and 8 with congenital heart disease(CHD) were selected to measure potassium and magnesium in myocardium, plasma and urine and aldosterone in plasma. Results The myocardial potassium and magnesium levels before operation were lower in RHD group than in CHD group.The peak of potassium excretion in urine was at 24 hours after operation in RHD group. Magnesium excretion levels in urine were the highest at 6 hours after operation. Aldosterone levels were higher in the patients with mitral valve disease in RHD group than the others during the perioperative period,aldosterone levels were the highest at 24 hourss after operation. Conclusion Normal electrolytic levels during perioperative period could decrease arrhythmia and myocardial injury. Myocardial potassium and magnesium levels before operation and 24 hours after operation were lower. The agents of potassium and magnesium should be utilized futher more.