体外循环搏动性血流灌注在心脏瓣膜置换术中的应用效果探讨

Effect of Extracorporeal Circulation Pulsatile Blood Perfusion in Heart Valve Replacement

目的探讨体外循环搏动性血流灌注在心脏瓣膜置换术中的应用效果。方法抽取2017年05月-2019年05月收治的106例行心脏瓣膜置换术治疗患者作为研究对象,应用随机数字表法分为传统组和观察组,各53例。其中传统组患者术中应用传统平流灌注进行干预,观察组患者术中应用体外循环搏动性血流灌注进行干预。比较分析两组患者转流前、转流后30、60、90 min及升主动脉开放时各生化指标及相关手术指标。结果转流前和升主动脉开放时,两组Hb、HCT、PLT和纤维蛋白原及转流后30、60、90 min HTC比较差异无统计学意义(P>0.05)。转流后30 min,相比传统组,观察组Hb、PLT和纤维蛋白原明显更高;转流后60 min和90 min,相比传统组,观察组Hb明显更高,PLT和纤维蛋白原明显更低,差异有统计学意义(P<0.05)。相比传统组,观察组术中尿量、术后血红蛋白尿例数、正性心肌药物例数明显更低,心脏复跳例数明显更高,下肢末梢皮肤温度恢复时间、正性心肌药物应用时间、呼吸机应用时间明显更短,差异有统计学意义(P<0.05)。两组患者术后引流量比较差异无统计学意义(P>0.05)。结论在心脏瓣膜置换术中应用体外循环搏动性血流灌注明显优于传统平流灌注,值得广泛推广。

Objective To investigate the effect of extracorporeal circulation pulsatile perfusion in heart valve replacement.Methods 106 patients undergoing cardiac valve replacement from May 2017 to May 2019 were selected as the subjects of this study,and were divided into traditional group and observation group with random number table method,53 patients in each.Traditional advection perfusion was used for intervention in the traditional group,and extracorporeal circulation pulsating blood perfusion was used for intervention in the observation group.The biochemical indexes and relevant surgical indexes before and 30,60,and 90 min after bypass and when the ascending aorta was opened.between the two groups were compared and analyzed.Results There was no significant difference in Hb,HCT,PLT and fibrinogen between the two groups and HTC at 30,60 and 90 min after bypass(P>0.05).The Hb,PLT and fibrinogen in the observation group were significantly higher than those in the traditional group 30 min after bypass.60 min and 90 min after bypass,compared with the traditional group,Hb in the observation group was significantly higher,PLT and fibrinogen were signiificantly lower,and the differences were statistically significant(P<0.05).Compared with the traditional group,the observation group had significantly lower intraoperative urine volume,postoperative hemoglobinuria cases,and positive myocardial drug cases,and significantly higher cardiac rebeat cases,as well as significantly shorter recovery time of lower extremity skin temperature,positive myocardial drug application time,and ventilator application time,with statistically significant differences(P<0.05).There was no significant difference in postoperative drainage volume between the two groups(P>0.05).Conclusion Extracorporeal circulation pulsating blood perfusion is better than traditional advection perfusion in heart valve replacement.