摘要
目的分析同期心脏瓣膜手术对左心室辅助装置(LVAD)置入患者围手术期心肌和肾功能损伤的影响。方法纳入2018年5月至2023年3月于郑州大学华中阜外医院接受LVAD置入的终末期心力衰竭(心衰)患者17例,根据是否同期行心脏瓣膜手术分为单独LVAD组(3例)和伴随手术组(14例)。采用重复测量方差分析比较两组患者围手术期心肌损伤酶学标志物和肾功能指标变化,比较两组并发症及手术相关资料。结果两组术前、术后1周、术后1月肌酸激酶同工酶(CK-MB)、肌红蛋白(Mb)、超敏肌钙蛋白(Hs-cTnT)、N端-B型钠尿肽前体(NT-proBNP)、血肌酐(Scr)和肾小球滤过率(eGFR)比较差异均无统计学意义(P>0.05)。单独LVAD组术前、术后1周、术后1月CK-MB、Mb、Hs-cTnT、NT-proBNP、Scr和eGFR两两比较差异均无统计学意义(P>0.05)。伴随手术组两两比较结果显示,与术前相比,术后1周CK-MB、Mb、NT-proBNP和Scr升高差异均无统计学意义(P>0.017),Hs-cTnT升高和eGFR降低差异有统计学意义(P<0.01),术后1月CK-MB、Mb、Hs-cTnT、NT-proBNP和Scr升高和eGFR降低差异均无统计学意义(P>0.017);与术后1周相比,术后1月Mb、Hs-cTnT、Scr降低和eGFR升高差异有统计学意义(P<0.017)。两组手术时间、机械通气时间、ICU停留时间和术后住院时间比较差异均无统计学意义(P>0.05)。与单独LVAD组相比,伴随手术组术中出血量、体外循环时间、主动脉阻断时间增加差异有统计学意义(P<0.05),但两组住院期间死亡、并发症发生情况比较差异均无统计学意义(P>0.05)。结论LVAD置入同期行心脏瓣膜手术可能不会造成严重的心肌缺血性损伤和肾损伤,不会显著增加围手术期死亡率和并发症发生率。
Objective To explore the impact of concomitant cardiac valvular surgery on perioperative myocardial and renal impairment in patients with left ventricular assist device(LVAD).Methods A total of 17 end-stage heart failure patients who underwent LVAD implantation at Central China Fuwai Hospital of Zhengzhou University from May 2018 to March 2023 were included.According to whether a concomitant cardiac valvular surgery was performed,3 patients were as in the LVAD alone group and 14 patients in the concomitant surgery group.Repeated-measures ANOVA was used to compare the perioperative changes in enzymatic markers of myocardial injury and indices of renal function between the two groups and to compare the complications and surgery-related data.Results There were no statistically significant differences in the comparison of CK-MB,Mb,Hs-cTnT,NT-proBNP,Scr,and eGFR between the two groups at preoperatively,1 week postoperatively,and 1 month postoperatively.The two-by-two comparisons of CK-MB,Mb,Hs-cTnT,NT-proBNP,Scr,and eGFR in the LVAD alone group were not statistically significant at preoperatively,1-week postoperatively,and 1-month postoperatively(P>0.05).The results of two-by-two comparisons in the concomitant surgery group showed that compared with the preoperative period,the differences in elevated CK-MB,Mb,NT-proBNP and Scr were not statistically significant at 1 week preoperatively(P>0.017),and the differences in elevated Hs-cTnT and decreased eGFR were statistically significant(P<0.01);the differences in elevated CK-MB,Mb,Hs-cTnT,NT-proBNP and Scr were not statistically significant at 1 month preoperatively(P>0.017).The differences in Mb,Hs-cTnT,Scr reduction,and eGFR elevation were statistically significant at 1 month postoperatively compared with 1 week preoperatively(P<0.017).There was no statistically significant difference in the comparison of operation time,mechanical ventilation time,ICU stay,and postoperative hospitalization time between the two groups(P>0.05).Compared with the LVAD alone group,the differ
作者
王志华
陈乾坤
胡俊龙
孙俊杰
李昭
刘前进
程兆云
WANG Zhi-hua;CHEN Qian-kun;HU Jun-long;SUN Jun-jie;LI Zhao;LIU Qian-jin;CHENG Zhao-yun(Department of Cardiac Surgery,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 451464,China;Department of Cardiac Surgery,Zhengzhou No.7 People’s Hospital,Zhengzhou 450016,China)
出处
《中国心血管病研究》
CAS
2023年第8期690-696,共7页
Chinese Journal of Cardiovascular Research
基金
河南省重点研发专项(221111310300)
河南省医学科技攻关计划项目(LHGJ20220111)
河南省医学科技攻关计划项目(SBGJ202101005)。
关键词
心力衰竭
左心室辅助装置
心脏瓣膜手术
心肌损伤
肾损伤
Heart failure
Left ventricular assist device
Cardiac valvular surgery
Myocardial injury
Kidney injury
