心脏瓣膜置换患者围手术期血清缺血修饰蛋白水平变化及与心肺功能的关系研究
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摘要
目的探讨心脏瓣膜置换患者围手术期血清缺血修饰蛋白水平变化及其与心肺功能的关系。方法选取需进行心脏瓣膜置换患者98例为研究对象,根据NYHA分级将患者分为Ⅲ级组(52例)和Ⅳ级组(46例),检测血清中IMA浓度和心肺功能指标,并对2组患者术后IMA峰值与心肺功能指标进行相关性分析,同时对不同预后围手术期患者血清IMA水平进行比较。结果组内比较,Ⅲ级组和Ⅳ级组术后IMA水平均逐渐增高,在术后第12小时达到高峰,然后逐渐降低,差异有统计学意义(P<0.05);组间比较,Ⅳ级组各时间点IMA水平均较Ⅲ级组IMA水平高(P<0.05);与Ⅲ级组相比,Ⅳ级组术前LVEF降低,多巴胺使用量、使用时间和呼吸机辅助呼吸时间增高,差异有统计学意义(P<0.05)。Ⅲ级组和Ⅳ级组患者术后IMA峰值与术前LVEF、术后第7天LVEF、多巴胺的使用量、使用时间和呼吸机辅助呼吸时间均呈正相关(r=0.346、0.362、0.316、0.298、0.467、0.412、0.447、0.391、0.362、0.642,P<0.05);Ⅲ级组和Ⅳ级组无并发症患者IMA水平均较有并发症患者低(P<0.05)。结论心脏瓣膜置换患者围手术期血清缺IMA水平变化能准确反应患者心肺功能的情况,对患者病情评估及临床处理具有一定的指导意义。
Objective To investigate perioperative changes of serum ischemia-modified albumin(IMA) levels and its relationship with cardiopulmonary function in patients with heart valve replacement. Methods Ninety eight cases who underwent heart valve replacement in our hospital were selected as the subjects. According to the NYHA classification, the patients were divided into grade Ⅲ group(n=52) and grade Ⅳ group(n=46). The serum levels of IMA and cardiopulmonary function indexes were detected. The correlation between IMA peak value after surgery and cardiopulmonary function indexes in two groups of patients were analyzed. In the meantime, the serum IMA levels were compared in patients with different prognosis during perioperative period. Results For intra-group comparison, the IMA levels in grade Ⅲ and Ⅳ groups were increased incrementally after surgery, which reached the peak at 12 h after surgery, and then gradually decreased, and the difference was statistically significant(P<0.05). In terms of between-group difference, the IMA levels of grade Ⅳ group at each time point were higher than those of grade Ⅲ group(P<0.05). Compared with grade Ⅲ group, the preoperative LVEF was lower in the Ⅳ group, while dosage of dopamine, the duration of drug use and duration of ventilator assisted respiration were increased. The difference was statistically significant(P<0.05). The postoperative IMA peaks in patients in grade Ⅲ and Ⅳ groups were positively correlated with preoperative LVEF, LVEF at 7 days after surgery, dosage of dopamine, duration of drug use, and duration of ventilator assisted respiration(r=0.346, 0.362, 0.316, 0.298, 0.467, 0.412, 0.447, 0.391, 0.362, 0.642, P<0.05). IMA levels in patients without complications were lower than those with complications in grade Ⅲ and Ⅳ groups(P<0.05).Conclusion Perioperative changes of serum IMA levels in patients undergoing cardiac valve replacement can accurately reflect the cardiorespiratory function of patients, which is of guiding significance for the evaluation of patients' condition and clinical treatment.
Objective To investigate perioperative changes of serum ischemia-modified albumin(IMA) levels and its relationship with cardiopulmonary function in patients with heart valve replacement. Methods Ninety eight cases who underwent heart valve replacement in our hospital were selected as the subjects. According to the NYHA classification, the patients were divided into grade Ⅲ group(n=52) and grade Ⅳ group(n=46). The serum levels of IMA and cardiopulmonary function indexes were detected. The correlation between IMA peak value after surgery and cardiopulmonary function indexes in two groups of patients were analyzed. In the meantime, the serum IMA levels were compared in patients with different prognosis during perioperative period. Results For intra-group comparison, the IMA levels in grade Ⅲ and Ⅳ groups were increased incrementally after surgery, which reached the peak at 12 h after surgery, and then gradually decreased, and the difference was statistically significant(P<0.05). In terms of between-group difference, the IMA levels of grade Ⅳ group at each time point were higher than those of grade Ⅲ group(P<0.05). Compared with grade Ⅲ group, the preoperative LVEF was lower in the Ⅳ group, while dosage of dopamine, the duration of drug use and duration of ventilator assisted respiration were increased. The difference was statistically significant(P<0.05). The postoperative IMA peaks in patients in grade Ⅲ and Ⅳ groups were positively correlated with preoperative LVEF, LVEF at 7 days after surgery, dosage of dopamine, duration of drug use, and duration of ventilator assisted respiration(r=0.346, 0.362, 0.316, 0.298, 0.467, 0.412, 0.447, 0.391, 0.362, 0.642, P<0.05). IMA levels in patients without complications were lower than those with complications in grade Ⅲ and Ⅳ groups(P<0.05).Conclusion Perioperative changes of serum IMA levels in patients undergoing cardiac valve replacement can accurately reflect the cardiorespiratory function of patients, which is of guiding significance for the evaluation of patients' condition and clinical treatment.
引文
1 刘艳,彭淑华,付晓丽.冠状动脉旁路移植同期行心脏瓣膜置换术治疗冠心病合并心脏瓣膜病的临床观察.实用医学杂志,2016,32:2686-2688.
2 Varrica A,Satriano A,Adw G,et al.S100B increases in cyanotic versus noncyanotic infants undergoing heart surgery and cardiopulmonary bypass (CPB).J Matern Fet al Neonatal Med,2017,28:1-7.
3 潘传亮,胡星,刘剑萍.术中容量超负荷对体外循环心脏术后患者预后的影响:一项前瞻性观察性研究.中华危重病急救医学,2016,28:592-596.
4 丁艳琼,王建荣,于亚群.术前呼气阻力训练对体外循环冠状动脉旁路移植术患者围术期肺功能的影响.中国体外循环杂志,2017,15:96-99.
5 Svendsen S,Elvevoll B,Mongstad A,et al.Fluid filtration and vascular compliance during cardiopulmonary bypass:effects of two volatile anesthetics.Acta Anaesthesiologica Scandinavica,2016,60:882.
6 赵峰,张雁.不同剂量右美托咪定对体外循环心脏瓣膜置换手术患者心肌损伤及血流动力学的影响.中国循证心血管医学杂志,2016,8:567-570.
7 刘晓鸽,潘小燕,刘爱胜,等.联合检测h-FABP、Mb、cTnI和CK-MB在儿童手足口病合并心肌损伤早期诊断的临床价值.中国医学装备,2016,13:89-92.
8 Muhtarolu S,Barlak KD,ünlühizarci K.Investigation of ischemia-modified albumin levels and some atherosclerosis-related serum parameters in patients with diabetic foot.Turkish Journal of Medical Sciences,2016,46:126-132.
9 Nishimura RA,Otto CM,Bonow RO,et al.2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Journal of the American College of Cardiology,2017,63:252-289.
10 吴士青,王伟.上海金山石化地区老年非瓣膜病性心房颤动急性进行性缺血性脑卒中的抗凝研究.临床急诊杂志,2016,10:801-802.
11 马星星,张义和,刘虎,等.二尖瓣置换术中保留后瓣及瓣下结构对风湿性心脏瓣膜病二尖瓣狭窄患者NT-proBNP的影响.检验医学与临床,2017,13:3552-3554.
12 赵艳荣,张国斌,邴飞虹.银杏黄酮对心肌缺血再灌注损伤大鼠的心肌保护作用及其作用机制研究.实用心脑肺血管病杂志,2016,24:38-42.
13 陈卓,魏继承.不同肢体远隔缺血后处理方法对瓣膜置换术患者血清心肌肌钙蛋白T浓度及术后恢复的影响.广西医学,2016,38:226-229.
14 Jena I,Nayak SR,Behera S,et al.Evaluation of ischemia-modified albumin,oxidative stress,and antioxidant status in acute ischemic stroke patients.J Nat Sci Biol Med,2017,8:110-113.
15 Beyazit F,Yilmaz N,Balci O,et al.Evaluation of Oxidative Stress in Women with Polycystic Ovarian Syndrome as Represented by Serum Ischemia Modified Albumin and Its Correlation with Testosterone and Insulin Resistance.Intern Med,2016,55:2359-2364.
16 肖平喜,谭明娟,万芳,等.血清缺血修饰白蛋白在冠心病患者中的临床应用价值.标记免疫分析与临床,2017,24:374-377.
17 乔利阳,杜长春,周向东.缺血修饰清蛋白、胱抑素C及氨基末端脑钠肽前体对急性冠状动脉综合征的联合诊断价值.中国临床医学,2017,24:416-419.
18 Wahab MK.Ischemia modified albumin (IMA)in acute coronary syndrome (ACS)and left bundle branch block (LBBB).Does it make the difference.Egyptian Heart Journal,2017,41:183-190.
19 徐彬,付建平,张羽.缺血修饰白蛋白、同型半胱氨酸对老年急性冠状动脉综合征患者早期诊疗的影响.中国煤炭工业医学杂志,2017,13:1296-1300.
20 蔡会欣,曹辉彩,张志强,等.缺血修饰清蛋白在冠心病患者经皮冠状动脉介入术前后的水平变化.检验医学与临床,2016,13:2510-2512.
2 Varrica A,Satriano A,Adw G,et al.S100B increases in cyanotic versus noncyanotic infants undergoing heart surgery and cardiopulmonary bypass (CPB).J Matern Fet al Neonatal Med,2017,28:1-7.
3 潘传亮,胡星,刘剑萍.术中容量超负荷对体外循环心脏术后患者预后的影响:一项前瞻性观察性研究.中华危重病急救医学,2016,28:592-596.
4 丁艳琼,王建荣,于亚群.术前呼气阻力训练对体外循环冠状动脉旁路移植术患者围术期肺功能的影响.中国体外循环杂志,2017,15:96-99.
5 Svendsen S,Elvevoll B,Mongstad A,et al.Fluid filtration and vascular compliance during cardiopulmonary bypass:effects of two volatile anesthetics.Acta Anaesthesiologica Scandinavica,2016,60:882.
6 赵峰,张雁.不同剂量右美托咪定对体外循环心脏瓣膜置换手术患者心肌损伤及血流动力学的影响.中国循证心血管医学杂志,2016,8:567-570.
7 刘晓鸽,潘小燕,刘爱胜,等.联合检测h-FABP、Mb、cTnI和CK-MB在儿童手足口病合并心肌损伤早期诊断的临床价值.中国医学装备,2016,13:89-92.
8 Muhtarolu S,Barlak KD,ünlühizarci K.Investigation of ischemia-modified albumin levels and some atherosclerosis-related serum parameters in patients with diabetic foot.Turkish Journal of Medical Sciences,2016,46:126-132.
9 Nishimura RA,Otto CM,Bonow RO,et al.2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Journal of the American College of Cardiology,2017,63:252-289.
10 吴士青,王伟.上海金山石化地区老年非瓣膜病性心房颤动急性进行性缺血性脑卒中的抗凝研究.临床急诊杂志,2016,10:801-802.
11 马星星,张义和,刘虎,等.二尖瓣置换术中保留后瓣及瓣下结构对风湿性心脏瓣膜病二尖瓣狭窄患者NT-proBNP的影响.检验医学与临床,2017,13:3552-3554.
12 赵艳荣,张国斌,邴飞虹.银杏黄酮对心肌缺血再灌注损伤大鼠的心肌保护作用及其作用机制研究.实用心脑肺血管病杂志,2016,24:38-42.
13 陈卓,魏继承.不同肢体远隔缺血后处理方法对瓣膜置换术患者血清心肌肌钙蛋白T浓度及术后恢复的影响.广西医学,2016,38:226-229.
14 Jena I,Nayak SR,Behera S,et al.Evaluation of ischemia-modified albumin,oxidative stress,and antioxidant status in acute ischemic stroke patients.J Nat Sci Biol Med,2017,8:110-113.
15 Beyazit F,Yilmaz N,Balci O,et al.Evaluation of Oxidative Stress in Women with Polycystic Ovarian Syndrome as Represented by Serum Ischemia Modified Albumin and Its Correlation with Testosterone and Insulin Resistance.Intern Med,2016,55:2359-2364.
16 肖平喜,谭明娟,万芳,等.血清缺血修饰白蛋白在冠心病患者中的临床应用价值.标记免疫分析与临床,2017,24:374-377.
17 乔利阳,杜长春,周向东.缺血修饰清蛋白、胱抑素C及氨基末端脑钠肽前体对急性冠状动脉综合征的联合诊断价值.中国临床医学,2017,24:416-419.
18 Wahab MK.Ischemia modified albumin (IMA)in acute coronary syndrome (ACS)and left bundle branch block (LBBB).Does it make the difference.Egyptian Heart Journal,2017,41:183-190.
19 徐彬,付建平,张羽.缺血修饰白蛋白、同型半胱氨酸对老年急性冠状动脉综合征患者早期诊疗的影响.中国煤炭工业医学杂志,2017,13:1296-1300.
20 蔡会欣,曹辉彩,张志强,等.缺血修饰清蛋白在冠心病患者经皮冠状动脉介入术前后的水平变化.检验医学与临床,2016,13:2510-2512.