心脏不停跳与停跳心瓣膜置换术后护理的对比观察

目的 探讨心脏不停跳二尖瓣置换与心脏停跳二尖瓣置换术后护理工作量及其临床意义。方法 30例行二尖瓣置换术的病人随机分成3组，A组：心脏不停跳组，B组：间断灌注冷晶心脏停搏液组，C组：连续灌注温血心脏停搏液组。对比观察3组不同心肌保护方法下进行二尖瓣置换术血液心肌肌钙蛋白T（cTnT)、术后心输出量（CO），正性肌力药物使用、心律失常和使用临时起搏器等情况。结果 cTnT在转机后即升高4.77-8.80ng/ml，且持续到术后2周，但A组的升高值（6.51ng/ml)较B组（7.43ng/ml)和C组（7.79ng/ml)低（P＜0.01)，A组术后心输出量（CO,5.14L/min)较术前（4.14L/min)明显改善，心律失常，低心排综合征发生率低，血管活性药用量少，患住重症监护病房（ICU）时间短。结论 心脏不停跳瓣膜置换术较心脏停跳瓣膜置换术后心功能稳定，并发症少，明显地减少了药品使用和护理工作量，是一种较理想的心肌保护方法和手术方式。

Comparison of post-operative nmsing of mitral valve replacement in beating heart and in cardioplegia arrest with CPB

ObjectiveTo study the significance of intensive care and clinical comparison of post operative nurse of mitral valve replacement in beating heart and in cardioplegic arrest with CPB.Methods30 patients of rheumatic heart diseases undergoing operation of mitral valve replacement were divided into 3 groups: Group A (beating heart group); Group B (cold blood cardioplegia group with intervallic heart perfusion); Group C (warm blood cardioplegia group with continuous heart perfusion). Cardiac troponin T (cTnT), post operative usage of positively inotropic drugs such as dopamine, heart rhythm and cardiac output (CO) were observed.ResultscTn T in all groups increased after CPB ( P <0.05), but higher in groups B and C than in Group A. CO in group A was higher than in other groups ( P <0.01) at stopping CPB and 1 h after operation. The dosage of Dopamine in groups B and C was larger than in group A ( P <0.05). Transient pace making was adopted in 5 cases in group B and 3 in group C. No patients died in each group.ConclusionThe heart function after mitral valve replacement in beating heart remains more stable than in cardioplegia arrest with CPB. The complications after replacement, the application of drugs and nursing care can be reduced noticeably. It is an ideal method for continuous protection of myocardium.