控制氧分压对体外循环下心脏瓣膜置换患者术后肾功能的影响

The effects of arterial oxygen partial pressure during cardiopulmonary bypass on renal function in patients with rheumatic valvular heart disease

目的通过观察控制氧分压对体外循环（CPB）下心脏瓣膜置换患者术后肾功能的影响，探讨肾保护措施。方法53例风湿性心脏患者随机分为两组：高氧分压组（H组，n=26）及控制氧分压组（C组，n=27）。C组与H组PaO2分别控制在100～250mmHg、300-500mmHg。于术前（T0）、CPB后24h（T1）、48h（T2）、72h（T3）、96h（T4）采集动脉血，全自动生化分析仪（日立7600）对血尿素氮（BUN）、血清胱抑素-C（Cys—C）、肾小球率过滤（GFR）检查。结果H组：与T0比较，CPB后各时间点BUN、Cys—C值均明显升高、而GFR降低，差异有统计学意义（P〈0．05），从T2时点后各时间点BUN、Cys—C逐渐下降、而GFR逐渐升高，与T1比较，差异有统计学意义（P〈0．05），但T4时点各指标均未恢复到术前。C组：T1与T0比较，BUN、Cys—C及GFR值差异有统计学意义（P〈0．05），其余各时点BUN、Cys—C值有升高、GFR降低趋势，但与T0比无统计学差异。两组组间同时点比较无明显差异。结论心脏瓣膜患者CPB后24h肾功能受损最明显：CPB中控制PaO2在100～250mmHg,可促进肾功能的恢复，对肾脏具有一定的保护作用。

Objective To explore the renal protective measures by investigating the effects of PaO2 on renal function during eardiopulmonary bypass in patients with rheumatic valvular heart disease. Methods Fifty-three patients were randomly divided into two groups： the hyperoxie group （ group H, n = 26 ） and the eontrol group （ group C, n = 27）. PaO2 in the control group was controlled between 100 and 250 mm Hg during CPB, and 300-500 mm Hg in hyperoxie group. Blood samples were obtained before operation （TO）, and at 24 hours （T1）, 48 hours（T2）, 72 hours （T3）and 96 hours （T4） after CPB respectively in two groups. Blood urea nitrogen, Cystatin C and glomelular filtration rate were detected by hitachi 7600 automatic biochemicl analyzer. Results In group H, BUN and Cys-C significant increased after CPB each time point as compared with before operation （ P 〈0.05） , while GFR decreased（ P 〈0.05 ）, and then BUN and Cys-C decreased gradually and GFR increased from T2. Compared with T1, T2 to T4 showed a significant difference（ P 〈0.05）, and did not restorepre-operative leveltill T4. group C ： BUN, Cys-C and GFR were significantly changed at T1 （ P 〈0.05） , but compared with TO, the values were not statistieally different at T2 to T4. The parameters were not significantly different between group H and C at the same time. Conclusion The renal funetionwas impairedre markably 24 h after CPB. Control of PaO2（ 100-250 mm Hg） during eardiopulmonary bypass may promote the recovery of renal function after valve surgery.