心脏瓣膜置换患者围手术期血清缺血修饰蛋白水平变化及与心肺功能的关系研究

目的探讨心脏瓣膜置换患者围手术期血清缺血修饰蛋白水平变化及其与心肺功能的关系。方法选取需进行心脏瓣膜置换患者98例为研究对象,根据NYHA分级将患者分为Ⅲ级组(52例)和Ⅳ级组(46例),检测血清中IMA浓度和心肺功能指标,并对2组患者术后IMA峰值与心肺功能指标进行相关性分析,同时对不同预后围手术期患者血清IMA水平进行比较。结果组内比较,Ⅲ级组和Ⅳ级组术后IMA水平均逐渐增高,在术后第12小时达到高峰,然后逐渐降低,差异有统计学意义(P<0.05);组间比较,Ⅳ级组各时间点IMA水平均较Ⅲ级组IMA水平高(P<0.05);与Ⅲ级组相比,Ⅳ级组术前LVEF降低,多巴胺使用量、使用时间和呼吸机辅助呼吸时间增高,差异有统计学意义(P<0.05)。Ⅲ级组和Ⅳ级组患者术后IMA峰值与术前LVEF、术后第7天LVEF、多巴胺的使用量、使用时间和呼吸机辅助呼吸时间均呈正相关(r=0.346、0.362、0.316、0.298、0.467、0.412、0.447、0.391、0.362、0.642,P<0.05);Ⅲ级组和Ⅳ级组无并发症患者IMA水平均较有并发症患者低(P<0.05)。结论心脏瓣膜置换患者围手术期血清缺IMA水平变化能准确反应患者心肺功能的情况,对患者病情评估及临床处理具有一定的指导意义。

老年患者心脏瓣膜置换围手术期的护理效果观察

目的探讨老年患者心脏瓣膜置换围手术期的护理效果。方法：选取来我院行心脏瓣膜置换术的112例老年患者。随机分为2组，对照组给予常规护理方法，观察组在此基础上采取围手术期护理。比较2组间平均住院天数、费用，不良反应发生率及满意度差别。结果：观察组的平均住院天数及费用、低心排血量、心律失常、肺部并发症的发生率均低于对照组，而满意度高于对照组，2组间以上差异均具有统计学意义（P〈0．05）。结论：对老年患者采用心脏瓣膜置换围手术期护理，不但能显著减少平均住院天数及费用，还能明显降低不良反应发生率及提高满意度，因此值得在临床中推广应用。

早期高浓度补钾在心脏瓣膜置换术后的应用及疗效观察

目的:为了早期迅速纠正心脏瓣膜置换术后低血钾,我们针对40例病人术后均给予高浓度补钾,有效地防止了术后因低血钾引起的心律失常。方法:采用微量泵经锁骨下静脉推注氯化钾,浓度30‰,速度以1g/h为宜。结果:本组40例病人均在术后2～4h内血钾恢复到正常水平,无心律失常的发生。结论:早期高浓度补钾在心脏瓣膜置换术后应用有效地防止了术后低血钾引起的心律失常,使病人顺利度过危险期,起到一定的作用。

Role of thrombus precursor protein in assessment of anticoagulation in patients with atrial fibrillation after mechanical heart valve replacement

Objective: To explore the role of thrombus precursor protein (TpP) in assessment of anticoagulation and predict the risk of thromboembolism in the patients with atrial fibrillation (AF) after mechanical heart valve replacement. Methods: TpP plasma concentration and international normalization ratio (INR) were measured in 45 patients with atrial fibrillation and 45 patients with sinus rhythm both after mechanical heart valve replacement. Twenty patients with non valvular heart diseases were selected as the control. Furthermore, the patients with AF were divided into groups based on different TpP plasma concentration and TpP plasma concentration and INR were analyzed. Results: After mechanical heart valve replacement, those with AF had higher TpP plasma concentration than those with sinus rhythm. It was found that discordancy existed between INR and TpP plasma concentration in the patients with AF. There were 28 AF patients with TpP plasma concentration lower than 6 μg/ml and without bleeding, who might be at the optimal anticoagulant state. The 95% confidence of the mean INR value was 1.90-2.30 in these patients and TpP plasma concentration was between 2.84-5.74 μg/ml. Conclusion: Patients with AF might face higher risk of thromboembolism after mechanical valve replacement; INR between 1.90-2.30 and TpP plasma concentration between 2.84-6 μg/ml might be the optimal anticoagulant range for patients with AF after mechanical valve replacement.

Thrombus precursor protein for monitoring anticoagulation in patients with mechanical valve prosthesis

Objective: To evaluate the plasma concentration of thrombus precursor protein (TPP) in patients after mechanical heart valve replacement, and to explore whether it can be used as a marker for monitoring anticoagulation. Methods: Totally 60 patients who took warfarin after mitral valve replacement and 20 control patients with non-valvular heart diseases were subjected in this study. Their plasma TPP concentration and international normalized ratio (INR) were determined, and compared not only between the anticoagulant patients and the control patients, but also between the patients with atrial fibrillaiton (AF, n=37) and the patients with sinus rhythm (SR, n=23) after mechanical valve replacement. The relationship between plasma TPP concentration and INR in the 60 anticoagulant patients was analyzed with linear regression. Results: It was found that the anticoagulant therapy effectively decreased plasma TPP concentration and elevated INR. In the anticoagulant group, the patients with AF had higher plasma TPP concentration than the others with sinus rhythm (P<0.05), although there was no significant difference in INR level between these 2 groups of patients (P>0.05). No significant correlation was found between plasma TPP concentration and INR in the anticoagulant patients (P>0.05). INR did not accord with plasma TPP concentration in several patients. Conclusion: INR can’t reflect the coagulation status and guide the anticoagulation correctly sometimes; TPP may be a valuable assistant marker for monitoring anticoagulation in patients with mechanical heart valve prothesis; Patients with AF may require higher density of anticoagulation and TPP is strongly suggested to be monitored in these patients.