常温心肺转流不停跳二尖瓣置换术对肾功能的影响

Effects of normothermic beating mitral valve replacement under CPB on renal function

目的探讨常温心肺转流(CPB)不停跳二尖瓣置换术对肾功能的影响。方法 60例二尖瓣置换术患者随机均分为不停跳组(A组)和停跳组(B组),分别于转机前(T0)、转机15min(T1)、停机后(T2)及停机后12h(T3)、24h(T4)、48h(T5)同步测定血/尿β2-微球蛋白(β2-MG)、血尿素氮(BUN)、血清肌酐(SCr)和尿N-乙酰-β-D-氨基葡萄糖苷酶(NAG)。结果与CPB前比较,两组CPB中和CPB后BUN和SCr均无明显改变(P>0.05)。A组T1-T3时血/尿β2-MG和尿NAG均明显高于T0(P<0.05);T4、T5恢复正常。B组T1-T5的血/尿β2-MG和尿NAG均明显高于T0,且T4、T5时明显高于A组(P<0.05)。结论常温不停跳二尖瓣置换术对肾功能的影响较停跳换瓣术者小。

Objective To investigate the effects of normothermic beating mitral valve replacement under cardiopulmonary bypass（CPB） on renal functiorL Methods Sixty patients undergoing mitral valve replacement under normothermic CPB were equally randomized into two groups of A （with heart beating） and B （with cardiac arrest）. The measurements of blood urea nitrogen （BUN）, serum creatinine （SCr） ,β2-microglobulin（β2-MG） in blood and urine, and urine N-acetyl-β-D amino glucoside enzyme（NAG） were performed at the same time points of before CPB（T0）, at 15 min in CPB（T1）, at the end of CPB（T2） ,at 12 h（T3）,24 h（T4）,and 48 h（T5） after CPB. Results Compared to before, the BUN and SCr in both groups were not significantly changed during and after CPB（P〉0.05）. The β2-MG in blood and urine, and urine NAG in group A were higher at T1-T3 than those at TO （P〈0. 05） ,which returned to normal at T4 and T5. The β2-MG in blood and urine,and urine NAG in group B were higher at T1-T5 than those at T0（P〈0. 05）,which at T4 and T5 were higher in group B than those in group A（P〈0. 05）. Conclusion Mitral valve replacement with beating heart under normothermic CPB has less effect on renal function than that with cardiac arrest.