CAJ | 학술논문

目的：探讨心脏复跳期间不同氧浓度灌流对心脏瓣膜置换患者心肌再灌注损伤和早期预后的影响。方法30例择期行心脏瓣膜置换手术患者随机分为A、B两组，每组15例。通过调整氧浓度使升主动脉开放前1 min至开放后10 min两组患者体外循环灌注氧分压（PaO2）分别维持在200 mm Hg（A组）和400 mm Hg（B组）左右。观察两组患者手术开始前（T0）、升主动脉开放前（T1）、升主动脉开放10 min（T2）、升主动脉开放30 min（T3）、术后6 h（T4）及24 h（T5）血清磷酸肌酸激酶同工酶（ CKMB）、心肌钙蛋白T（ cTnT）浓度，记录两组患者气管导管带管时间、ICU时间及术后住院时间。结果 T1时两组患者CKMB和cTnT即显著高于T0（ P＜0．01），至T4时达到高峰，T5时两组患者CKMB水平均下降至T1水平。 T0时两组患者CKMB和cTnT基础值无显著差异（ P＞0．05），T1～T5时A组CKMB水平显著低于B组（ P＜0．05）；T2～T5时A组cTnT水平显著低于B组（ P＜0．05）。 A组患者术后气管导管带管时间、ICU停留时间和术后住院时间均小于B组，但组间比较无统计学意义（ P＞0．05）。结论高PaO2复灌停跳心脏，可以导致术后短期内心肌损伤血清标志物的升高，但临床上未表现出对早期预后的不良影响。
목적：탐토심장복도기간불동양농도관류대심장판막치환환자심기재관주손상화조기예후적영향。방법30례택기행심장판막치환수술환자수궤분위A、B량조，매조15례。통과조정양농도사승주동맥개방전1 min지개방후10 min량조환자체외순배관주양분압（PaO2）분별유지재200 mm Hg（A조）화400 mm Hg（B조）좌우。관찰량조환자수술개시전（T0）、승주동맥개방전（T1）、승주동맥개방10 min（T2）、승주동맥개방30 min（T3）、술후6 h（T4）급24 h（T5）혈청린산기산격매동공매（ CKMB）、심기개단백T（ cTnT）농도，기록량조환자기관도관대관시간、ICU시간급술후주원시간。결과 T1시량조환자CKMB화cTnT즉현저고우T0（ P＜0．01），지T4시체도고봉，T5시량조환자CKMB수평균하강지T1수평。 T0시량조환자CKMB화cTnT기출치무현저차이（ P＞0．05），T1～T5시A조CKMB수평현저저우B조（ P＜0．05）；T2～T5시A조cTnT수평현저저우B조（ P＜0．05）。 A조환자술후기관도관대관시간、ICU정류시간화술후주원시간균소우B조，단조간비교무통계학의의（ P＞0．05）。결론고PaO2복관정도심장，가이도치술후단기내심기손상혈청표지물적승고，단림상상미표현출대조기예후적불량영향。
Objective To approach the effects of different partial pressure of oxygen during reperfusion on myocardial injury and early postoperative outcomes of patients with heart valve replacement. Methods 30 patients with rheumatic heart disease undergo-ing heart valve replacement surgery were randomized equally into two groups. The patients in group A received controlled partial pres-sure of oxygen approximately 200 mmHg, but it was instead of 400 mmHg in group B by adjusting oxygen concentration. Blood samples were collected via the radial artery at the time of before the surgery ( T0) , before aortic declamping ( T1) , 10 min ( T2) and 30 min ( T3) after release of the aortic crossclamp, 6 h ( T4) and 24 h ( T5) after the surgery for MB isoenzyme of creatine kinase ( CKMB) and cardiac troponin T ( cTnT) monitoring in both groups. The outcomes of patients included duration of intubation ( DOI) , length of intensive care unit stay ( LOI) and length of hospital stay after the surgery ( LOH) were also recorded. Results Compared to T0, both the concentrations of CKMB and cTnT were increased from T1 to T4 and reached the tops at T4 in two groups, and those at T5 were de-creased but only the concentration of CKMB near to T0. The serum CKMB level in group A was significant lower than in group B from T1 to T5, and the level of cTnT in group A was obviously lower than in group B from T2 to T5. The DOI, LOI and LOH in group A were shorter in group B, but there was not statistically significant between two groups. Conclusion Arrest heart reperfused by oxygen-ated blood with higher partial pressure of oxygen can result in significant increase of serum marker of myocardial injury, but would not affect early postoperative outcomes of patients with heart valve replacement.