亚低温血液净化治疗心脏瓣膜病术后低心排血量综合征的临床研究

目的：探讨亚低温血液净化（CBP）在心脏瓣膜病术后低心排血量综合征（LCOS）治疗中的作用以及可行性.方法：将在我院行心脏瓣膜置换术后发生LCOS的68例患者,随机分为常温治疗组（NT组）36例和亚低温治疗组（HT组）32例,分别统计比较2组入选时、治疗后1、2、3d的APACHEⅡ评分、多器官功能不全（MODS）评分、氧输送/氧消耗（DO2/VO2）比值、氧合指数、心指数（CI）、肺毛细血管楔压（PAWP）、出血量以及病死率、住ICU时间、呼吸机辅助时间、CBP时间、感染发生率、心律失常等.结果：NT组治疗后1、2、3d氧合指数、PAWP、Lac较治疗前明显改善（均P＜0.05）,其余指标无显著差异（均P＞0.05）.HT组治疗后1dDO2/VO2比值、氧合指数、PAWP、Lac较治疗前明显改善（均P＜0.05）；治疗后2、3d各指标均明显改善（均P＜0.05）.HT组的病死率、住ICU时间、呼吸机辅助时间、CBP时间均低于NT组（均P＜0.05）；2组出血量、感染例数、心律失常发生例数无显著差异（均P ＞0.05）.结论：亚低温血液净化能有效改善心脏瓣膜病术后LCOS的氧供需平衡,从而延缓MODS病程进展,缩短机械通气、CBP及住ICU时间,减少病死率；且不增加出血、感染和心律失常发生率.

Clinical study of mild hypothermic continuous blood purification in treatment of postoperative low cardiac output syndrome after heart valve replacement

Objective：To discuss the efficacy and feasibility of mild hypothermic continuous blood purification （CBP） in treatment of postoperative low cardiac output syndrome （LCOS） after heart valve replacement.Methods：Sixty-eight cases developed LCOS after heart valve replacement in our hospital were randomly divided into two groups：normothermic CBP group （group NT,n =36） and mild hypothermic CBP group （group HT,n =32）.The score of APACHE Ⅱ and multiple organ dysfunction syndrome （MODS）,ratio of DO2/VO2,oxygenation index,cardiac index,pulmonary capillary wedge pressure （PAWP）,lactic acid,the amount of bleeding,mortality,duration in ICU,time of mechanical ventilation and CBP,infection rate and arrhythmia of the two groups were compared at admission,one day,2 days and 3 days after treatment.Results：The oxygenation index,PAWP and lactic acid were obviously improved in the group NT one day,2 days and 3days after treatment （P ＜ 0.05）.The DO2/VO2,oxygenation index,PAWP and lactic acid in group HT were obviously improved after treatment （P ＜ 0.05）.Two and three days after treatment,the above all indexes improved significantly （P ＜ 0.05）.The mortality,duration in ICU,time of mechanical ventilation and CBP were lower in the group HT than those in group NT （P ＜ 0.05）.There were no significant differences in the amount of bleeding,infection rates and arrhythmia of the two groups （P ＞ 0.05）.Conclusions：Treatment of mild hypothermic CBP effectively improve the balance of DO2 and VO2,delay the progression of MODS,shorten the time of mechanical ventilation,CBP and duration in ICU,reduce the mortality,but do not increase bleeding,infection and incidence of arrhythmia.