摘要
目的:比较常温和亚低温下连续血液透析治疗瓣膜病术后心源性休克的效果及对患者心功能、心衰指标和炎性因子的影响.方法:选取我院2020年1月到2022年12月收治的90例瓣膜病术后心源性休克患者,分为观察组与对照组,各45例.对照组患者采取常温下连续血液透析治疗,观察组患者采取亚低温下连续血液透析治疗,对比两组患者术后引流量、血液净化时间、呼吸机辅助时间、ICU入住时间以及死亡、心律失常、感染发生情况,对比两组患者治疗前后左心室射血分数(LVEF)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)心功能指标,BNP(B型利钠肽)、超敏C反应蛋白(hs-CRP)、血肌酐(Cr)心衰实验室指标,炎症因子表法水平.结果:两组患者心律失常、感染发生率对比无差异(P＞0.05),观察组术后引流量、呼吸机辅助时间ICU入住时间、血液净化时间及死亡率较对照组低(P＜0.05);治疗前两组患者LVESV、LVEF、LVEDV对比无明显差异(P＞0.05),治疗后两组患者LVEF均升高,且观察组较对照组高,LVESV、LVEDV水平降低,观察组较对照组低(P＜0.05);治疗前两组患者BNP、hs-CRP、Cr相关心衰实验室指标对比无差异(P＞0.05),治疗后两组患者BNP、hs-CRP、Cr相关心衰实验室指标均降低,观察组低于对照组(P＜0.05);治疗前两组患者白细胞介素-6(IL-6)、白细胞介素-1(IL-1)、肿瘤坏死因子-α(TNF-α)炎性因子水平对比无差异(P＞0.05),治疗后水平均降低,且观察组较对照组低(P＜0.05).结论:对瓣膜病术后心源性休克患者采取亚低温下血液净化治疗与常温下血液透析治疗相比能欧进一步减少患者术后引流量、血液净化时间,促进患者早日康复的同时能够降低患者死亡率,同时采取亚低温下血液透析治疗能够进一步改善患者心功能,减轻心衰情况,降低患者机体炎症因子水平.
Abstract
Objective:To compare the effects of continuous hemodialysis at room temperature and mild hypothermia on postoper-ative cardiogenic shock in patients with valve disease,as well as its impact on cardiac function,heart failure indicators,and inflammatory factors.Methods:90 patients of postoperative cardiogenic shock after valvular disease admitted from January 2020 to December 2022 were selected and divided into observation group and control group with 45 cases each.The control group patients were treated with con-tinuous hemodialysis at room temperature,while the observation group patients were treated with continuous hemodialysis treatment at mild hypothermia.The postoperative drainage volume,blood purification time,ventilator assistance time,ICU stay time,as well as the incidence of death,arrhythmia,and infection were compared between the two groups of patients.The left ventricular ejection fraction(LVEF)before and after treatment was compared between the two groups of patients Left ventricular end systolic volume(LVESV),left ventricular end diastolic volume(LVEDV),cardiac function indicators,BNP(B-type natriuretic peptide,B-type natriuretic peptide),hy-persensitive C-reactive protein(hs CRP),and blood creatinine(Cr)laboratory indicators for heart failure,Interleukin-6(IL-6),Inter-leukin-1(IL-1),Tumor Necrosis Factor-α(TNF-α)Inflammatory factor expression level.Results:There was no difference in the incidence of arrhythmia and infection between the two groups(P＞0.05),postoperative drainage rate,ventilator assisted time ICU admission time,blood purification time and mortality in the observation group were lower than that of the control group(P＜0.05);There was no signifi-cant difference in LVESV,LVEF and LVEDV between the two groups before treatment(P＞0.05),LVEF was elevated in both groups after treatment,and the observation group was higher than the control group,Lower levels of LVESV and LVEDV,The observation group was lower than the control group(P＜0.05);BNP,hs-CRP,and Cr between the two groups before treatment(P＞0.05),After treat-ment,BNP,hs-CRP,and Cr related HF laboratory indicators were decreased in both groups.The observation group was lower than the control group(P＜0.05);The levels of interleukin-6(IL-6),Ileukin-1(IL-1),tumor necrosis factor-α(TNF-α)were not different between the two groups(P＞0.05),both levels were reduced after the treatment,and the observation group was lower than the control group(P＜0.05).Conclusion:Compared with normothermic hemodialysis,mild hypothermia blood purification treatment can further reduce postoperative drainage flow and blood purification time,promote early recovery,and reduce patient mortality.At the same time,adopting mild hy-pothermia hemodialysis treatment can further improve patient heart function,alleviate heart failure,and lower the level of inflammatory factors in the patient's body.
基金项目
新疆维吾尔自治区自然科学基金(2020D01C089)
维普
万方数据