主动脉内球囊反搏用于重症心脏瓣膜病瓣膜置换术的效果

The effects of intra-aortic balloon counterpulsation for valve replacement in patients with severe valvular heart disease

目的评价主动脉内球囊反搏（intra-aortic balloon counterpulsation，IABP）用于重症心脏瓣膜病瓣膜置换术的效果。方法拟行心脏手术的重症瓣膜病患者60例，采用随机数字表法将其分为两组，每组30例：研究组（A组）患者术前置入IABP备心脏复跳后行反搏，对照组（B组）不用IABP。于转机前（T2）、转机后60min（T3）、停机时（T4）、术后6（T5）、12（T6）、24（T7）、48h（T8）时记录两组患者尿量及分别抽取静脉血测定血清磷酸肌酸激酶（creatine kinase，CK）、肌酸激酶同功酶（creatine kinase-MB，CK-MB）、心肌肌钙蛋白I（cardiact roponinI，cTnI）、血乳酸（1actic acid，Lac）的值。记录两组患者围术期临床资料。结果与B组比较，两组各时点平均动脉压（mean artery pressure，MAP）、心率（heartrate，HR）、中心静脉压（central venous pressure，CVP）、左房压（left atrial pressure，LAP）、尿量、手术时间、心血管急救（emergency cardiaccare，ECC）时间、心脏复跳率比较差异无统计学意义（P〉0．05）；A组L～R时CK[（623±45）、（432±34）、（339±40）、（252±21）U／L]，CK-MB[（172±37）、（146±29）、（122±29）、（78±21）U／L]，cTnI[（48．84±7．73）、（41．33±8．30）、（30．80±6．42）、（20．23±6．02）μg／L]，Lac[（3．1±0．8）、（2．1±0．9）、（1．5±0．7）、（1．2±0．5）mmol／L]均明显降低（P〈0．05），术后多巴胺[（7．2±2．1）μg·kg^-1·min^-1]、多巴酚丁胺[（7．2±2．1）μg·kg^-1·min^-1]用量明显减少（P〈0．05），且肾上腺素使用例数（0／30）显著减少（R0．01），呼吸机辅助呼吸时间[（18.3±7．6）h]、重症监护室（ICU）停留时间[（4．8±1．2）d]、术后住院时间[（13．8±4．8）d]均缩短（P〈0．05），早期死亡率（0／30）显著下降（R0．01）。结论IABP用于重症心脏瓣膜病瓣膜置换术，在心脏复跳后行IABP支持，对术后心肌有一定的保护作用，可以降低死亡率，提高手术的成功率。

Objective To evaluate the effects of intra-aortic balloon pump （IABP） for valve replacement in patients with severe valvular heart disease. Methods The 60 patients with severe valvular heart disease who need surgical treatment were randomly divided into treated groups （n=30） and control group （n=30） with random digits table. The patients in treated group were inplanted with IABP preoperatively and cardiac resuscitated after operation. The patients in control group were not inplanted with IABP. The hemodynamie parameters in different time [time before anesthesia （To）, 5 rain after induction of anesthesia （T1）, before cardio pulmonary bypass（T2）, 60 min after cardio pulmonary bypass（T3）, the termination of cardio pulmonary bypass（T4）, 6 h after surgery（T5）, 12 h after surgery（T6）, 24 h after surgery（T7） 48 h after surgery（T8）] were recorded. During of T2-T8, urine volume was recorded and venous blood was extracted for quantifying the serum creatine kinase （CK）, the creatine kinase-MB （CK-MB）, cardiac troponin I （cTnI）, laetie acid （Lac）. Other parameters were also reeorded. Results Parameters of mean artery pressure（MAP）, heart rate （HR）,central venous pressure （CVP）,left atrial pressure （LAP） urine output, operation time, emergency eardiac care （ECC）, cardiac resuscitation rate difference in treated group and control group were not significant different （P〉0.05） at each time point. The plasma concentration of CK in at T5-T8 [（623±45）, （432±34）, （339±40）, （252±21） U/L] and CK-MB [（172±37）, （146±29）, （122±29）, （78±21） U/L] and cTnI [ （48.84±7.73）, （41.33±8.30）, （30.80±6.42）, （20.23±6.02）μg/L] and Lac [（3.1±0.8）, （2.1±0.9）, （1.5±0.7）, （ 1.2±0.5 ） mmol/L ] in treated group were signifieantly lower than control group （P〈0.05）. The consumption of dopamine[ （7.2±2.1）μg·kg^-1·min^-1] and dobutamine [（7.2±2.1 ） μg·kg^-1·min^-1] after surgery were significantly reduced （P〈0.05）, and the cases applied of adrenaline（0/30） were also significant reduced （P〈0.01） in treated group. The time of ventilation time [ （18.3±7.6） h ], time of ICU stayed [ （4.8±1.2） d ], hospitalization time after surgery （13.8±4.8） d and mortality （0/30） in treated group were lower than that in control group （P〈0.05）. Conclusions Preoperative inplantation of IABP in patients with severe valvular heart disease during surgery of valve replacement could protect the myocardium, increased the survival of patients.