【摘要】 目的探讨心脏瓣膜置换术后围术期室性心律失常的相关因素、规律、量值、防治措施以指导临床。方法根据研究内容对513例心内直视手术患者,分3个时间段、多因素、三项课题进行系统研究:课题1.对风湿性心脏瓣膜替换术病人于术后48小时内分别记录术后4小时、术后12小时、术后24小时、术后32小时、术后40小时、术后48小时、血清钾与室性心律失常例次、补钾量和尿量进行对比观察。课题2.对266例体外循环手术患者采用2种不同补钾方法及用量,术中进行补钾,观察血清钾浓度与室性心律失常的相互关系。课题3.将147例心脏瓣膜置换术病人按术式、血清钾浓度、主动脉阻断时间、心胸比例、心功能、体外循环时间、心率、血压、中心静脉压、心肌正性药物的应用等术后60小时内5个时间段,观察记录室性心律失常例次进行分析对比研究。结果课题1血钾<3.5mmol/L组,发生室性心律失常为77.9%;血钾3.5~3.9mmol/L组为41.8%;血钾4.0~4.5mmo/L组为22.6%;血钾>4.5mmol/L组为10.6%;血钾<3.5mmo/L组与>4.5mmol/L组相比,两组差异有极显著性(P<0.01)。课题2补钾方法1组,主动脉开放时血钾>4.1mmol/L者为37.7%;补钾方法2组,主动脉开放时血钾>4.1mmol/L者为94.9%。课题3结果显示,血钾<3.5mmol/L与>4.1mmol/L组间相比有极显著性差异(P<0.01),主动脉阻断时间>90分钟与<60分钟组相比有极显著差异(P<0.01),心胸比>0.8与<0.8组间相比有显著性差异(P<0.05),心功能IV级与心功能Ⅱ级组相比有极显著性差异(P<0.01)。结论心脏瓣膜替换术后引起室性心律失常增多的主要因素依次为血清钾<3.5mmol/L;心胸比>0.8;主动脉阻断时间>90分钟;心功能IV级;及体外循环时间>150分钟;心率<60次/分钟;AMP<50mmHg;CVP>20cmH2O;及异丙肾上腺素应用>48小时。更多还原

【Abstract】 Objective In order to guide clinical operation the relative factors,regularity,quantitative prevention measures for abnormal rhythm of ventricles after heart valve replacement were studied.Method Systematic studies were done on 513 patients with open heart operation separated in 3 time segments,multi-factors and three subjects: Topic 1.For rheumatic heart disease patients with valve replacement within 48 hours after operation in 4 hours’ time,12 hours,24 hours,32 hours,40 hours and 48 hours record separately kalium in blood serum and happening times of abnormal rhythm of ventricles,make-up quantity of kalium and amount of urine.To compare and observe above-mentioned items.Topic 2.For 266 patients with extra-corporeal circulation two different ways and quantities of making up kalium were applied.Making up kalium during operation.To observe the relative relationship between density of kalium and abnormal rhythm of heart ventricles.Topic 3.Separating 147 patients with heart valve replacement by way of operation,density of kalium,interdiction time of aortic artery,ratio of heart and breast,heart function,extra-corporeal circulation time,rhythm of the heart,blood pressure,central vein pressure and application of positive medicine for heart muscle.60 hours after operation and in 5 phases record the times of abnormal rhythm of heart ventricles.To compare and study above figures.Result Topic 1.When kalium in blood serum is 3.5mmol/L the ARHV（abnormal rhythm of heart ventricles） is 77.9%.When kalium in blood serum is 3.5³.9mmol/L the ARHV is 41.8%.When kalium in blood serum is 4.0⁴.5mmol/L ARHV is 22.6%.When kalium in blood serum is >4.5mmol/L ARHV is 10.6%.Comparing groups with kalium in blood serum less than 3.5mmol/L and more than 4.5mmol/L there is a remarkable difference（P<0.01）.Topic 2.Kalium make-up group 1: Kalium in blood serum>4.1mmol/L with open aortic artery the ARHV is 37.7%.Kalium make-up group 2: Kalium in blood serum >4.1mmol/Lwith open aortic artery ARHV is 94.9%.Topic 3.The results indicates: There is an outstanding difference for following groups in P value: group of kalium in blood serum<3.5mmol/L and group of kalium in blood serum >4.1mmol/L P is <0.01.Group with aortic artery interdiction time >90 minutes and <60 minutes P is <0.01.Group of heart and breast ratio >0.8 and <0.8 P is <0.05.Heart function grade IV compared with II P is <0.01.Conclusion The sequential factors for increase of abnormal rhythm of ventricles after heart valve replacement operation are as following: group of kalium in blood serum<3.5mmol/L,group of aortic artery interdiction time>90 minutes,group of heart and breast ration is >0.8,heart function grade IV,group of extra-corporeal circulation time>150 minutes,group of rhythm of heart is <60 minutes,AMP<50mmHg,CVP>20mmH₂O and group with application of isoproterenol more than 48 hours.更多还原