芪参益气滴丸预处理对瓣膜置换患者右室心脏功能影响的研究

发布时间：2018-04-02 05:25

本文选题：芪参益气滴丸　切入点：药物预处理　出处：《第三军医大学》2014年硕士论文

【摘要】：背景及目的：目前对体外循环下心脏瓣膜置换手术患者心肌保护的研究很多，但多集中在心肌停搏液及各种添加剂的研究，本研究旨在探讨现代中药制剂芪参益气滴丸(Qishen Yiqi Pills)预处理对体外循环下心脏瓣膜置换手术患者的心肌保护以及对右室心脏功能的影响。方法：将我院心血管外科2012年5月-2013年5月间，需在体外循环下行瓣膜置换手术的患者120例随机分为两组：对照组（A组）60例和芪参组（B组）60例。术前：对照组常规治疗基础上，应用芪参益气滴丸安慰剂，餐后半小时服用，每次药物量为0.5g，每日3次，持续至研究结束；芪参组在常规治疗的基础上,应用芪参益气滴丸，餐后半小时服用，每次药物量为0.5g，每日3次，持续至研究结束。在麻醉前（T0）及主动脉开放后12h(T1)和24h(T2)两组患者分别抽血检测血清心肌损伤标志物磷酸肌酸酶同工酶（CK-MB）和肌钙蛋白I（nTnI）。于术前及术后第1周、第6周分别测量两组患者右室射血分数(RVEF)、右心室输出量(RVSV)、右心室舒张期末容积(RVEDV)和右心室收缩期末容积(RVESV)。并记录手术时体外循环时间、辅助循环时间、升主动脉阻断时间，，开放升主动脉后心脏自动复跳情况、体外循环停止后多巴胺用量、心律失常发生情况、术后停留监护室（ICU）时间。结果： 1.两组患者的体外循环时间、辅助循环时间、主动脉阻断时间的比较无显著差异性（P0.05）；B组心律失常发生率低于A组，两组患者的心律失常均为阵发性房颤，但在统计学上无显著差异性（P0.05）。 2.两组患者升主动脉开放后B组14例患者除颤心脏复跳，明显低于A组32例，两组心脏复跳情况比较存在显著差异（P0.05）。体外循环停止后平均多巴胺使用量A组平均在4.0±0.8μg/kg min，明显高于B组2.1±1.4μg/kg min，比较有显著差异(P0.05)。患者在ICU病房的时间A组4.2±1.3d，高于B组2.5±0.9d，比较有显著差异（P0.05）。术后两组患者cTnl浓度的是呈上升趋势，术后24小时A组cTnl为1.58±0.34ng/ml,B组cTnl为1.03±0.22ng/ml，两者比较有显著差异（P0.05）。术后两组患者CK-MB浓度升高，术后12小时A组CK-MB为26.89±5.04U/L,B组CK-MB为17.32±6.01U/L，于术后24小时A组CK-MB为22.36±5.37U/L,B组CK-MB为14.13±5.28U/L，两者比较均有显著差异（P0.05）。 3.手术前两组患者右心室舒张期末容积(RVEDV)、右心室收缩期末容积(RVESV)、右心室输出量(RVSV)及射血分数（RVEF）比较无明显差异性（P0.05）；手术后第1周及第6周时两组患者心脏超声显示右心室舒张期末容积(RVEDV)、右心室收缩期末容积(RVESV)、右心室输出量(RVSV)较术前均明显降低，而射血分数（RVEF）较术前明显升高，但B组术后右心室舒张期末容积(RVEDV)、右心室收缩期末容积(RVESV)、右心室输出量(RVSV)降低程度显著低于A组,差异具有统计学意义（P0.05)，而射血分数（RVEF）B组升高程度显著高于A组，差异具有统计学意义（P0.05)。结论：心脏瓣膜病患者术前常规治疗基础上加用芪参益气滴丸，可以增强心肌细胞抗缺氧能力，减少体外循环过程中缺血再灌注损伤的并发症,对改善术后患者右室心脏功能，促进术后恢复具有重要作用，对于体外循环下进行瓣膜置换手术后出现的心力衰竭的治疗开辟了新的途径，值得临床推广。
[Abstract]:Background and Purpose :

At present , there are many researches on myocardial protection in patients undergoing heart valve replacement under extracorporeal circulation , but it is focused on the study of cardiac arrest fluid and various additives . The purpose of this study is to discuss the effect of Qishen Yiqi dripping pill ( Qishen Yiqi dripping pill ) preconditioning on myocardial protection and right ventricular function in patients undergoing heart valve replacement during cardiopulmonary bypass .

Method :

The cardiovascular surgery in our hospital from May 2012 to May 2013 was divided into two groups : control group ( group A ) and Qishen group ( group B ) in 60 cases .
Serum myocardial injury markers ( RVEF ) , right ventricular output ( RVSV ) , right ventricular end - diastolic volume ( RVEDV ) and right ventricular end - systolic volume were measured before and after anesthesia ( T0 ) and 12 h ( T1 ) and 24 h ( T2 ) .

Results :

1 . There was no significant difference in the cardiopulmonary bypass time , the auxiliary circulation time and the aortic cross - blocking time between the two groups ( P0.05 ) .
The incidence of arrhythmia in group B was lower than that in group A . The arrhythmias in both groups were paroxysmal atrial fibrillation , but there was no statistically significant difference ( P0.05 ) .

There was a significant difference between the two groups ( P < 0.05 ) . The levels of serum CK - MB in group B were significantly higher than those in group B ( P < 0.05 ) . The levels of serum CK - MB in group B were significantly higher than those in group B ( P < 0.05 ) . The levels of CK - MB in group B were significantly higher than those in group B ( P < 0.05 ) .

3 . There was no significant difference between the right ventricular end - diastolic volume ( RVEDV ) , the end - of - end volume of the right ventricle ( RVSV ) , the right ventricular output ( RVSV ) and ejection fraction ( RVEF ) in the two groups before surgery ( P0.05 ) .
At the 1st and 6th weeks after surgery , the right ventricular end - diastolic volume ( RVEDV ) , the end - of - systolic volume of the right ventricle ( RVET ) and the right ventricular output ( RVSV ) were significantly lower than those in group A ( P0.05 ) .

Qi Shen Yiqi dripping pill can be added on the basis of conventional treatment before operation of patients with valvular heart disease , so that the anti - anoxia ability of the myocardial cells can be enhanced , the complications of ischemia reperfusion injury in the process of cardiopulmonary bypass are reduced , the function of the right ventricle of the right ventricle of the patient after operation is improved , the postoperative recovery is important , and a new approach is opened for the treatment of heart failure after the valve replacement surgery under extracorporeal circulation , and is worthy of clinical popularization .

【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R259

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