心脏瓣膜替换术后室性心律异常相关因素临床探讨
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摘要
目的：探讨心脏瓣膜置换术后室性心律异常的相关因素和规律，提出防治措施以指导临床。
方法：将147例心脏瓣膜手术分成三组：单瓣膜置换、双瓣膜置换及瓣膜置换加左房血栓清除，按病种术式、血清钾浓度、主动脉阻断时间、心功能、心胸比例、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，在术后60小时内分成5个时间段，分别观察、记录偶发室性早搏、频发室性早搏、室性二联律、三联律、室速、室颤等室性心律失常例次，然后进行分析对比研究。
结果：1．主动脉瓣加二尖瓣替换(DVR)：血钾＜3.5mmol／L组，术后60小时5个时间段内室性心律异常发生率为75％(9／12)，心胸比≥0.8组为57.8％(11／19)，主动脉阻断时间＞90分钟组为46.8％(30／64)，心功能Ⅳ级组为57.5％(46／80)。2．左房血栓清除加瓣膜替换(LATEVR)：血钾＜3.5mml／L组，术后60小时5个时间段内室性心律异常发生率为76.9％(10／13)，主动脉阻断时间＞90分钟组为58.9％(23／39)，心胸比≥0.8组为50％(5／10)，心功能Ⅳ级组为48.5％(34／70)。3．二尖瓣替换(MVR)：血钾＜3.5mmol／L组，术后60小时5个时间段内室性心律异常发生率为64％(16／25)，主动脉阻段时间＞90分钟组为55.1％(27／49)，心胸比≥0.8组为48.2％(14／29)，心功能Ⅳ级组为31.4％(50／159)。全组结果显示，血钾＜
心脏瓣膜替换术后室性心律异常相关因素临床探讨中文摘要
3.smmol/L与>4.Ommol/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分钟组相比也有极显著差异，P<0.01;心胸比全0.8与<0.8组间
相比有极显著性差异，P<0.01;心功能IV级与心功能11级组，两组相比有极显著
，胜差异，P<0.01。
结论:心脏瓣膜替换术后引起室性心律异常增多的主要因素为:血清钾<
3.smmoFL，主动脉阻断时间>0分钟，心功能IV级，心胸比全0.8，及体外循环
时l旬>150分钟组，心率<60次/分钟组，AMp<50mmHg组，Cvp>0emH20
组，异丙基肾上腺素应用>8小时组。
Objective : In order to guide clinical operation, discussion on the relative factors, regularity for abnormal rhythm of ventricles after heart valve replacement.
Methods: Separate 147 patients with mitral valve replacement (MVR), double valves replacement (DVR), left atrium thrombus eliminate and valve replacement (LATEVR) in 3 time segments by the 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. Compare and study above figures.
Results: 1. In the group of DVR , when kalium in blood serum is less than 3.5mmol/L .after operation 60 hours in 5 phases the ARHV (abnormal rhythm of heart ventricles) is 75%(9/12). Group of heart and breast ratio > 0.8, the ARHV is 57. 8%(11/19). Group with aortic artery interdiction time > 90 minutes , the ARHV is 46. 8%(30/46). Group of heart function grade IV, the ARHV is 57. 5%(46/80). 2 . In the group of LATEVR, when kalium in blood serum is less than 3. 5mmol/L , after operation 60 hours in 5 phases
the ARHV is 76. 9%(10/13). Group of heart and breast ratio > 0. 8, the ARHV is 50%(5/10). Group with aortic artery interdiction time > 90 minutes , the ARHV is 58. 9%(23/39). Group of heart function grade IV, the ARHV is 48. 5%(34/70). 3. In the group of MVR, when kalium in blood serum is less than 3. 5mmol/L .after operation 60 hours in 5 phases the ARHV is 64%(16/25). Group of heart and breast ratio > 0.8, the ARHV is 48.2%(14/29). Group with aortic artery interdiction time > 90 minutes , the ARHV is 55. 1%(27/49). Group of heart function grade IV, the ARHV is 31.4%(50/159). 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. 0 mmol/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. 01. Heart function grade IV compared with II , P is < 0.01.
Conclusions: The sequential factors for increase of abnormal rhythm of ventricles after heart valve replacement operation are as follows: group of kalium in blood serum < 3. 5mmol/L, group of aortic artery interdiction time >90 minutes, heart function grade IV, group of heart and breast ration is > 0. 8, group of extra- corporeal circulation time > 150 minutes, group of rhythm of heart is < 60 minutes, AMP < 50mmHg, CVP >20cmH20 and group with application of isoproterenol more than 48 hours.
方法：将147例心脏瓣膜手术分成三组：单瓣膜置换、双瓣膜置换及瓣膜置换加左房血栓清除，按病种术式、血清钾浓度、主动脉阻断时间、心功能、心胸比例、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，在术后60小时内分成5个时间段，分别观察、记录偶发室性早搏、频发室性早搏、室性二联律、三联律、室速、室颤等室性心律失常例次，然后进行分析对比研究。
结果：1．主动脉瓣加二尖瓣替换(DVR)：血钾＜3.5mmol／L组，术后60小时5个时间段内室性心律异常发生率为75％(9／12)，心胸比≥0.8组为57.8％(11／19)，主动脉阻断时间＞90分钟组为46.8％(30／64)，心功能Ⅳ级组为57.5％(46／80)。2．左房血栓清除加瓣膜替换(LATEVR)：血钾＜3.5mml／L组，术后60小时5个时间段内室性心律异常发生率为76.9％(10／13)，主动脉阻断时间＞90分钟组为58.9％(23／39)，心胸比≥0.8组为50％(5／10)，心功能Ⅳ级组为48.5％(34／70)。3．二尖瓣替换(MVR)：血钾＜3.5mmol／L组，术后60小时5个时间段内室性心律异常发生率为64％(16／25)，主动脉阻段时间＞90分钟组为55.1％(27／49)，心胸比≥0.8组为48.2％(14／29)，心功能Ⅳ级组为31.4％(50／159)。全组结果显示，血钾＜
心脏瓣膜替换术后室性心律异常相关因素临床探讨中文摘要
3.smmol/L与>4.Ommol/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分钟组相比也有极显著差异，P<0.01;心胸比全0.8与<0.8组间
相比有极显著性差异，P<0.01;心功能IV级与心功能11级组，两组相比有极显著
，胜差异，P<0.01。
结论:心脏瓣膜替换术后引起室性心律异常增多的主要因素为:血清钾<
3.smmoFL，主动脉阻断时间>0分钟，心功能IV级，心胸比全0.8，及体外循环
时l旬>150分钟组，心率<60次/分钟组，AMp<50mmHg组，Cvp>0emH20
组，异丙基肾上腺素应用>8小时组。
Objective : In order to guide clinical operation, discussion on the relative factors, regularity for abnormal rhythm of ventricles after heart valve replacement.
Methods: Separate 147 patients with mitral valve replacement (MVR), double valves replacement (DVR), left atrium thrombus eliminate and valve replacement (LATEVR) in 3 time segments by the 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. Compare and study above figures.
Results: 1. In the group of DVR , when kalium in blood serum is less than 3.5mmol/L .after operation 60 hours in 5 phases the ARHV (abnormal rhythm of heart ventricles) is 75%(9/12). Group of heart and breast ratio > 0.8, the ARHV is 57. 8%(11/19). Group with aortic artery interdiction time > 90 minutes , the ARHV is 46. 8%(30/46). Group of heart function grade IV, the ARHV is 57. 5%(46/80). 2 . In the group of LATEVR, when kalium in blood serum is less than 3. 5mmol/L , after operation 60 hours in 5 phases
the ARHV is 76. 9%(10/13). Group of heart and breast ratio > 0. 8, the ARHV is 50%(5/10). Group with aortic artery interdiction time > 90 minutes , the ARHV is 58. 9%(23/39). Group of heart function grade IV, the ARHV is 48. 5%(34/70). 3. In the group of MVR, when kalium in blood serum is less than 3. 5mmol/L .after operation 60 hours in 5 phases the ARHV is 64%(16/25). Group of heart and breast ratio > 0.8, the ARHV is 48.2%(14/29). Group with aortic artery interdiction time > 90 minutes , the ARHV is 55. 1%(27/49). Group of heart function grade IV, the ARHV is 31.4%(50/159). 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. 0 mmol/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. 01. Heart function grade IV compared with II , P is < 0.01.
Conclusions: The sequential factors for increase of abnormal rhythm of ventricles after heart valve replacement operation are as follows: group of kalium in blood serum < 3. 5mmol/L, group of aortic artery interdiction time >90 minutes, heart function grade IV, group of heart and breast ration is > 0. 8, group of extra- corporeal circulation time > 150 minutes, group of rhythm of heart is < 60 minutes, AMP < 50mmHg, CVP >20cmH20 and group with application of isoproterenol more than 48 hours.
引文
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