CAJ | 학술논문

目的观察术前不同次数的高压氧(hyperbaric oxygen,HBO)预处理对体外循环下行心脏瓣膜置换术患者的心肌保护作用.方法根据患者知情同意及医院伦理委员会批准,将80例拟行二尖瓣或主动脉瓣置换术患者分为对照组(20例)和3个观察组(预处理Ⅰ、Ⅱ、Ⅲ组,每组20例),对照组术前未给予HBO预处理,观察组术前分别给予1、3、5次HBO预处理,比较4组患者术前0.5h和术后1、3、6、12、24、48 h的血清肌钙蛋白Ⅰ(eTnⅠ)浓度以及术后1、3、6、12、24和48 h正性肌力药物用量评分的变化.结果 (1)4组患者术后cTnⅠ浓度均呈先升后降趋势,3个观察组在术后各个时间点的cTnⅠ浓度均低于对照组,其中预处理Ⅰ组在术后1、12、24、48 h与对照组比较差异有统计学意义(P＜0.05),预处理Ⅱ、Ⅲ组在术后各个时间点与对照组、预处理Ⅰ组之间的cTnⅠ浓度比较差异有统计学意义(P＜0.05),而与预处理Ⅱ、Ⅲ组之间无统计学差异(P＞0.05).(2)4组患者术后正性肌力药物用量评分随时间逐渐下降,预处理Ⅰ组在术后24 h及预处理Ⅱ、Ⅲ组在术后24、48 h与对照组比较差异有统计学意义(P＜0.05),但3个观察组在各个时间点的评分差异均无统计学意义(P＞0.05).结论术前重复的HBO预处理能对心脏瓣膜置换术后患者的心肌功能有较好的保护,其中术前重复3次HBO预处理能起到与重复5次HBO预处理相似的作用.
목적 관찰술전불동차수적고압양(hyperbaric oxygen,HBO)예처리대체외순배하행심장판막치환술환자적심기보호작용.방법 근거환자지정동의급의원윤리위원회비준,장80례의행이첨판혹주동맥판치환술환자분위대조조(20례)화3개관찰조(예처리Ⅰ、Ⅱ、Ⅲ조,매조20례),대조조술전미급여HBO예처리,관찰조술전분별급여1、3、5차HBO예처리,비교4조환자술전0.5h화술후1、3、6、12、24、48 h적혈청기개단백Ⅰ(eTnⅠ)농도이급술후1、3、6、12、24화48 h정성기력약물용량평분적변화.결과 (1)4조환자술후cTnⅠ농도균정선승후강추세,3개관찰조재술후각개시간점적cTnⅠ농도균저우대조조,기중예처리Ⅰ조재술후1、12、24、48 h여대조조비교차이유통계학의의(P＜0.05),예처리Ⅱ、Ⅲ조재술후각개시간점여대조조、예처리Ⅰ조지간적cTnⅠ농도비교차이유통계학의의(P＜0.05),이여예처리Ⅱ、Ⅲ조지간무통계학차이(P＞0.05).(2)4조환자술후정성기력약물용량평분수시간축점하강,예처리Ⅰ조재술후24 h급예처리Ⅱ、Ⅲ조재술후24、48 h여대조조비교차이유통계학의의(P＜0.05),단3개관찰조재각개시간점적평분차이균무통계학의의(P＞0.05).결론 술전중복적HBO예처리능대심장판막치환술후환자적심기공능유교호적보호,기중술전중복3차HBO예처리능기도여중복5차HBO예처리상사적작용.
Objective To observe the protective effects of hyperbaric oxygen (HBO)pretreatment with different sessions on the cardiac muscle in patients with cardiac valve replacement under extraeorporeal circulation.Methods Eight patients intended to receive mitral or aortic valve replacement were randomly divided into the control group and 3 observation groups (i.e.pretreatment group Ⅰ,Ⅱ and Ⅲ,each consisting of 20 patients).The observation groups had HBO pretreatment for 1,3 and 5 sessions respectively before surgery.The serum troponin Ⅰ (cTnⅠ) concentrations of the patients in the 4 groups were compared at hour 0.5 before operation and at hour 1,3,6,12,24 and 48 after surgery.Inotropic scores were also compared between the groups at hour 1,3,6,12,24 and 48 after surgery.Results (1) The cTnⅠ concentrations of the 4 groups tended to increase first,then,decreased.The cTnⅠ concentrations of the 3 pretreatment groups at various time points after surgery were all higher than those of the control group.Statistical differences could be seen in the cTnⅠ concentrations of pretreatment group Ⅰ at hour 1,12,24 and 48 after surgery,as compared with those of the control group.Statistical differences could also be seen in the cTnⅠ concentrations of pretreatment group Ⅱ and Ⅲ at various time points after surgery,as compared with those of the control group and pretreatment group Ⅰ (P ＞ 0.05).However,no statistical significance could be noted,when comparisons were made between pretreatment group Ⅱ and Ⅲ(P ＞ 0.05).(2) Inotropic scores in all patients of the 4 groups descended slowly over time.Statistical significance could be noticed in the scores of pretreatment group Ⅰ at hour 24 after surgery,and in the score of pretreatment group Ⅱ and Ⅲ at hour 24 and 48,when compared with those of the control group (P ＞ 0.05).However,no statistical differences in the scores of the 3 pretreatment groups could be found at various time points (P ＞ 0.05).Conclusions Repeated HBO pretreatment before surgery was beneficial to the cardiac function of those patients undergoing cardiac valve replacement.Three-session pretreatment before surgery could produce almost identical effects as 5-session pretreatment.