胸腔镜下心脏不停搏二尖瓣置换术的心肺保护研究

发布时间：2019-05-18 00:02

【摘要】：目的探讨胸腔镜与心脏不停搏技术结合的临床意义和价值,为临床手术方式的选择提供一定的参考。方法将该院胸心外科2012年9月至2015年9月收治的40例接受胸腔镜二尖瓣置换手术的风湿性心脏病-二尖瓣病变患者纳入研究。其中试验组(心脏不停搏组)20例,对照组(心脏停搏组)20例,将患者手术时间、体外循环时间、酶学指标、呼吸指数以及手术并发症等进行对比分析。结果两组各有1例患者死于术后低心排综合征,其余患者均顺利完成手术,术后均未出现低心排综合征、严重心律失常、空气栓塞等严重并发症,两组在手术时间、体外循环时间上差异无统计学意义(P0.05),但ICU停留时间两组差异有统计学意义(P0.05)。两组肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、乳酸脱氢酶(LDH)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)因子释放水平以及呼吸指数均有上升,但试验组水平显著低于对照组(P0.05)。结论胸腔镜心脏不停搏二尖瓣置换术比胸腔镜心脏停搏二尖瓣置换术对心肺的保护效果更好。
[Abstract]:Objective to explore the clinical significance and value of thoracoscopy combined with cardiac beating technique, and to provide some reference for the choice of clinical surgical methods. Methods from September 2012 to September 2015, 40 patients with rheumatic heart disease and mitral valve disease undergoing thoracoscopic mitral valve replacement were enrolled in the study. There were 20 cases in the experimental group (cardioplegia group) and 20 cases in the control group (cardioplegia group). The operation time, cardiopulmonary bypass time, enzyme index, respiratory index and surgical complications were compared and analyzed. Results one patient in each group died of low cardiac output syndrome after operation, and the other patients completed the operation successfully. No serious complications such as low cardiac output syndrome, severe arrhythmia and air embolism occurred after operation. There was no significant difference in cardiopulmonary bypass time (P 0.05), but there was significant difference in ICU residence time between the two groups (P 0.05). Two groups of creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), lactic dehydrogenase (LDH), tumor necrosis factor-伪 (TNF- 伪), IL-6 (IL-6), The release level of IL-8 (IL-8) factor and respiratory index were increased, but the level of IL-8 factor in the experimental group was significantly lower than that in the control group (P 0.05). Conclusion thoracoscopic mitral valve replacement is more effective than thoracoscopic mitral valve replacement in protecting heart and lung.
【作者单位】：广西壮族自治区人民医院心胸血管外科/胸部外科;
【基金】：广西医疗卫生重点科研课题(重200962) 广西壮族自治区卫生厅重点科研课题(重2011121、重2011112、重200521)
【分类号】：R654.2

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