大株红景天对巨大左心室瓣膜置换术患者围术期疗效观察

Beneficial effects of Sofren in the treament of patients with valvular heart disease combined huge left ventricle in the peri-operative period of valve replacement

目的观察大株红景天对巨大左心室瓣膜置换术患者围术期的疗效。方法将79例患者随机分为三组:极化液(GIK)组32例,给予GIK,即胰岛素10 U、10%氯化钾10 ml和50%的葡萄糖液50 ml加入到250 ml 10%的葡萄糖注射液,静脉滴注,每日1次,共10 d;大株红景天组23例,给予大株红景天,即大株红景天10 ml(800 U)加入到250 ml 5%的葡萄糖注射液中,入院后6 h内开始静脉滴注,每日1次,共10 d;大株红景天合用GIK组24例,入院后6 h内开始静脉滴注大株红景天10 ml(800 U),滴注完毕后继续给予GIK,每日1次,共10 d。观察三组患者术中心脏自动复跳率、术后恶性心律失常发生率、低心排出量综合征发生率以及围术期死亡率。结果大株红景天合用GIK组与GIK组、大株红景天组相比,能有效提高患者术中心脏自动复跳率(91.67%vs.60.50%vs.65.22%),降低术后恶性心律失常发生率(8.33%vs.30.50%vs.34.78%)及低心排出量综合征发生率(4.17%vs.28.12%vs.26.09%,P<0.05);大株红景天组与GIK组相比,患者术中心脏自动复跳率、恶性心律失常发生率和低心排出量综合征发生率差异无统计学意义(P>0.05);GIK组有1例死亡,死亡原因为术后低心排出量综合征。结论大株红景天合用GIK可提高患者术中心脏自动复跳率,降低术后恶性心律失常、低心排出量综合征发生率。

Objective To clarify the efficacy of Sofren in the treatment of patients with valvular heart disease combined huge left ventricle in the peri-operative period of valve replacement. Methods Seventy-nine patients were randomly divided to 3 groups： 32 patients received glucose-insulin-potassium solution（ GIK,consist of10 unit insulin,10% potassium chloride,50% 50 ml glucose,and 10% glucose 250 ml,intravenous drip per day,for10 days）; 23 patients received Sofren（ consist of 800 unit Sofren with 250 ml glucose,intravenous drip per day,for10 days,the treatment started within 6 h after patients were admitted）; 24 patients received Sofren plus GIK（ consist of800 unit Sofren with 250 ml glucose,intravenous drip followed by GIK dripping per day,for 10 days,the treatment started within 6 h after patients were admitted）. Intro-operative automatical recovery rate,malignant arrhythmia rate,lower output syndrome rate and peri-operative mortality were observed in three groups. Results Spontaneous heart re-beating rate,malignant arrhythmia rate,and lower output syndrome rate in Sofren plus GIK group were 91. 67%,8. 33% and 4. 17%,respectively,in GIK group were 60. 50%,30. 50% and 28. 12%,respectively,and in Sofren group were 65. 22%,34. 78% and 26. 09%,respectively）,spontaneous heart re-beating rate in Sofren plus Gik group was significantly higher than those in GIK group and Sofren groups（ P 0. 05） and malignant arrhythmia rate and lower output syndrome rate were much lower than GIK group and Sofren group（ P 0. 05）,but there was no difference between GIK group and Sofren group（ P 0. 05）. One patient died of post-operative lower output syndrome in GIK group. Conclusion Sofren plus GIK could improve intro-operative spontaneous heart re-beating,reduce occurrence of post-operative malignant arrhythmia rate and low output syndrome rate.