【作者】 张杰；

【导师】 王东进；

【作者基本信息】 南京中医药大学 ， 中西医结合临床， 2012， 硕士

【摘要】 目的：探讨持续性血液净化(continuous blood purification, CBP)对心脏瓣膜术后严重心功能衰竭的治疗效果及中医机理的探讨。方法：南京鼓楼医院心胸外科于2008年1月至2011年7月收治的符合一定标准的40例心脏瓣膜病患者,随机分为对照组和研究组,对照组仅应用常规方法(扩容、纠酸,使用多种正性肌力药物),而研究组则在此基础上加用CBP治疗,比较治疗前后两组的血流动力学指标、心脏超声参数、心肾功能和炎症反应指标。结果：研究组和对照组均为20例患者,平均年龄分别为(48.95±9.79)岁和(47.10±7.55)岁,两组患者的平均年龄、性别构成、手术相关数据、术后早期血流动力学、心脏超声参数、心肾功能和炎症反应指标均无显著性差异；治疗72小时两组在LAP、MAP、HR和CO上均有显著性差异,心脏超声指标中虽然心腔大小的改善在两组中并不明显,但CBP组左室EF值显著高于对照组,此外,CBP组的BNP, Cr和CRP水平在治疗72小时后均明显低于对照组,CBP组在血管活性药物的用量上也显著低于对照组。结论：应用CBP降低心脏负荷,减轻左心室压力,增加心肌收缩力,减少心脏做功,为治疗心脏瓣膜术后严重心功能衰竭提供了新的方法,同时CPB也可以视为心脏外科术后中医证型改变的动态过程。更多还原

【Abstract】 Objectives To explore the outcome of continuous blood purification(CBP) therapy for heart failure after cardiac valve operation and to study its TCM mechanisn.Methods Forty patients with rheumatic valvular disease admitted to cardiac-thoracic department of Nanjing Drum Tower Hospital were enrolled in this studys which, which were divided into two groups:trial group and control group. The patients in the control group were given common therapy and the others in trial group accepted CBP simultaneously. The indication of CBP included left atrium pressure(LAP) higher than15mmHg, mean arterial pressure(MAP) lower than55mmHg and left ventricle ejection fraction(LVEF) lower than forty percent after the usual care. The variables refer to hemodynamic, ultrasoundcardiography, heart function, renal function and inflammatory response in two groups were collected and analyzed.Results There were twenty patients in each group. The mean age was48.95±9.79in trial group and47.10±7.55in control group. No significant differences in the mean age, the percentage of male patients, operative data and variables about hemodynamic, ultrasoundcardiography, heart function, renal function and inflammatory response in early post-operation existed. However,72hours later, there were obviously distinctions in LAP、MAP、HR and CO between the two groups. The left ventricle eject fraction in trial group was higher than that in the control. Furthermore, for the patients with CBP therapy, BNP, Cr, CRP and the dose of vasoactive drugs were much lower than that of patients with usual therapy.Conclusions CBP can be used to improve the heart overload, reduces the left ventricular pressure,increase myocardial contractility, which may be a new choice for the management of severe heart failure after cardiac valve surgery.更多还原