心脉隆注射液对活动期感染性心内膜炎行体外循环下心脏瓣膜置换术后患者心功能的影响

Effects of Xinmailong injection on cardiac function in patients with active endocarditis after cardiac valve replacement under cardiopulmonary bypass

目的探究心脉隆注射液对活动期感染性心内膜炎(AIE)行体外循环(CPB)下心脏瓣膜置换术后患者心功能的影响。方法择期拟在CPB下行心脏瓣膜置换术的活动期感染性心内膜炎患者92例,性别不限,年龄18~70岁,体质指数18~30 kg/㎡,ASA分级Ⅱ-Ⅳ级,心功能分级Ⅱ-Ⅳ级,随机分为常规治疗的对照组(C组,n=46)、心脉隆加常规治疗的心脉隆组(X组,n=46)。患者术后直接入重症监护室(intensive care unit,ICU),入ICU后常规监测生命体征,X组在常规治疗的基础上给予心脉隆注射液,C组在常规治疗基础上给予等量的生理盐水,均为2次/d,共10 d。记录患者术前的一般情况,术中情况;并分别于麻醉诱导结束后、手术结束即刻(T1)、心脉隆使用5 d后(T2)、心脉隆使用10 d后(T3)采用经食管超声心动图(TEE)测量并记录两组患者的中心静脉压(CVP)、心脏左室射血分数(LVEF)、左室舒张末内径(LVDd)、计算心指数(CI);检测C反应蛋白(CRP)及N末端脑钠肽前体(NT_proBNP)的浓度。记录苏醒时间、拔管时间、ICU停留时间、血管活性药物使用时间、术后24 h引流量、住院时间、严重并发症发生率(如严重心律失常、心力衰竭、严重肺水肿、心源性休克、肾功能衰竭等)和术后60 d死亡率。结果两组患者术前及术中情况差异无统计学意义(P> 0.05);T2、T3时间点:与C组比较,X组的CVP值较低,LVEF、CI值较高,CRP及NT_proBNP浓度明显降低(P <0.05);X组拔管时间、ICU停留时间及血管活性药物使用时间缩短,心力衰竭、肺动脉高压、严重肺水肿及严重心律失常发生率明显降低(P <0.05)。结论对于活动期感染性心内膜炎行体外循环下心脏瓣膜置换术后患者,在常规治疗的基础上给予心脉隆注射液辅助治疗,可以明显改善患者的心功能,降低严重并发症的发生率,而且药物的不良反应发生率低,安全可行。

Objective To investigate the effect of Xinmailong injection on cardiac function of patients with active infective endocarditis(AIE)after cardiac valve replacement under cardiopulmonary bypass(CPB).Methods From September 2016 to December 2017 in Xuzhou Medical College Hospital,a total of 92 patients of both sexes,aged 18-70 yr,with American Society of Anesthesiologists physical statusⅡ-Ⅳ,body mass index 18 to 30 kg/m2,grading gradesⅡ-Ⅳ,received cardiac valve replacement surgery under CPB were enrolled in this study.Patients were divided into the control group(C group,n=46)and Xinmailong injection group(X group,n=46).All patients were transferred directly to the intensive care unit(ICU)after surgery,and the vital signs were routinely monitored.Patients in Group X received Xinmailong injection on the basis of routine treatment,and patients in group C received equal amount of physiologocal saline on the basis of routine treatment,twice a day for 10 days.Preoperative and intraoperative general conditions of patients were recorded at the end of induction of anesthesia,at the end of the operation(T1),5 days after the use of Xinmailong injection(T2)and 10 days after the use of Xinmailong injection(T3).The following data were collected in all patients,includingcentral venous pressure(CVP),left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVDd),and cardiac index(CI);concentrations of hypersensitive c-reactive protein(CRP)and amino-terminal pro-brain natriuretic peptide(NT-proBNP),wake-up time,extubation time,time of ICU stay,time for use of vasoactive drug,postoperative 24 h drainage,length of hospital stay,serious complications(such as severe arrhythmia,heart failure,severe pulmonary edema,cardiogenic shock,kidney failure,etc.)and 60-day mortality after surgery.Results There were no significant differences in preoperative general conditions and intraoperative surgical conditions between the two groups(P>0.05).Compared with group C,the value of CVP,the concentration of CRP and NT_proBNP at T2 and T3 were significantly decreased,the value of LVEF and CI were increased,the time for postoperative use of vasoactive drugs,extubation time and length of intensive care unit stay were shortened,the incidences of heart failure,pulmonary hypertension,severe pulmonary edema and severe arrhythmia were significantly reduced in X group(P<0.05,respectively).Conclusions For the patients with AlE received cardiac valve replacement surgery under CPB,adjunctive therapy with Xinmailong injection on the basis of routine treatment can significantly improve heart function and reduce the incidence of severe complications,meanwhile,the incidence of drug adverse reactions is very low and,the scheme is safe and feasible.