体外循环预充还原型谷胱甘肽对心脏瓣膜置换术患者的临床研究

Clinical Study of Cardiopulmonary Bypass Pre Filled Reduced Glutathione in Patients with Heart Valve Replacement

目的:观察体外循环(CPB)预充还原型谷胱甘肽(GSH)对心脏瓣膜置换术患者心肌损伤指标和炎症因子指标的影响。方法:选择2020年10月到2021年10月期间于我院行心脏瓣膜置换术治疗的180例患者。以随机数字表法分为对照组和研究组,均为90例。研究组患者CPB预充GSH 1200 mg,对照组患者预充等量氯化钠注射液。观察两组患者围术期指标、心肌损伤指标[肌酸激酶(CK)、乳酸脱氢酶(LDH)、肌钙蛋白Ⅰ(cTnⅠ)、肌红蛋白(Mb)]、炎症因子指标[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]变化,并记录两组并发症发生情况。结果:研究组术中转流时间、呼吸机使用时间、ICU留置时间、术后多巴胺使用天数短于对照组,术后多巴胺使用总量少于对照组(P<0.05)。主动脉开放后2 h、12 h、24 h,两组CK、LDH、cTnⅠ、Mb水平均升高后下降(P<0.05),且研究组CK、LDH、cTnⅠ、Mb水平低于对照组(P<0.05)。主动脉开放后2 h、12 h、24 h,两组IL-6、TNF-α水平均升高后下降(P<0.05),且研究组IL-6、TNF-α水平低于对照组(P<0.05)。研究组的并发症发生率低于对照组(P<0.05)。结论:CPB预充GSH可减轻心脏瓣膜置换术患者心肌损伤,有效控制炎症反应,同时还可降低并发症发生率,缩短呼吸机使用时间、术中转流时间、ICU留置时间、术后多巴胺使用天数,减少术后多巴胺使用总量,效果显著。

Objective:To observe the effects of cardiopulmonary bypass(CPB)pre filled reduced glutathione(GSH)on myocardial injury indexes and inflammatory factor indexes in patients with heart valve replacement.Methods:180 patients with heart valve replacement who were treated in our hospital from October 2020 to October 2021 were selected.They were divided into control group and study group by random number table method,all of which were 90 cases.Patients in the study group were pre charged with1200 mg GSH with CPB,and patients in the control group were pre charged with the same amount of sodium chloride injection.The changes of perioperative indexes,myocardial injury indexes[creatine kinase(CK),lactate dehydrogenase(LDH),troponin I(cTNⅠ),myoglobin(Mb)]and inflammatory factor indexes[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]were observed in two groups,and the complications of the two groups were recorded.Results:The intraoperative transit time,ventilator use time,ICU retention time and postoperative dopamine use days in the study group were shorter than those in the control group,and the total amount of postoperative dopamine use was less than that in the control group(P<0.05).At 2 h,12 h and 24 h after aortic opening,the levels of CK,LDH,cTNⅠand Mb in the two groups increased and then decreased(P<0.05),and the levels of CK,LDH,cTNⅠand Mb in the study group were lower than those in the control group(P<0.05).At 2 h,12 h and 24 h after aortic opening,the levels of IL-6 and TNF-αin the study group increased and then decreased(P<0.05),and the levels of IL-6 and TNF-αin study group were lower than those in control group(P<0.05).The incidence of complications in the study group was lower than that in the control group(P<0.05).Conclusion:CPB precharging GSH can reduce myocardial injury in patients undergoing heart valve replacement,effectively control inflammatory reaction,reduce the incidence of complications,shorten the use time of ventilator,intraoperative transit time,ICU retention time,postoperative dopamine use days,and reduce the total use of dopamine after operation.