Résumé
Objective To investigate the clinical value of blood recovery in the heart valve replacement surgery of adults. Methods Selected 556 patients accepted cardiac valve replacement surgery from May 2008 to April 2012 in our hospital,and divid-ed into control group(278 cases)and observation group(278 cases)according to the way of intraoperative blood transfusion patients in observation group underwent autologous blood recovery and patients in control group underwent without autologous blood recov-ery,the clinical parameters were observed and statistically analyzed.Results The differences of blood routine after 24 h(such as he-moglobin,hematocrit,platelets,etc.)and blood gas analysis(such as pH,potassium ions,lactic acid,etc.)between two groups were not significantly different,which is statistically insignificant(P >0.05);the postoperative chest drainage of patients in observation group was not significantly different from that of patients in control group,which was statistically insignificant(P >0.05);the a-mount of banked blood in observation group(263.83 ± 19.23)mL was significantly lower than that in control group(615.24 ± 20.34)mL,the difference between two groups was statistically significant(P <0.05).Conclusion In heart valve replacement sur-gery of adults,blood recovery can effectively add blood volume,reduce autologous blood loss,and significantly reduce the amount of banked blood input,which is worthy of promotion.
Résumé
Objective To compare the influence of whole sevoflurane inhaling and target-controlled infusion of propofol for the myocardial protective effect on patients with heart valve replacement surgery. Methods 30 adult patients who went through heart valve replacement surgery with cardiopulmonary by pass were selected, including ASA staging II-III and cardiac function classification (NYHA) II-III. All patients were randomly divided equally into sevoflurane group (Group S) and propofol group (Group P) . Patients were monitored before anesthetic induction. Group S got 1%sevoflurane (fresh gas flow 6 L/min) with concentration of the vaporizer increased from 1%to 3%with 1 minute interval during anesthetic induction. Group P got target-controlled infusion of propofol during anesthetic induction,the initial target plasma concentration was set at 0.8μg/mL,and the concentration increased 0.5 μg/mL every minute until intubation. All the patients got fentanyl 5 μg/kg and rocuronium 0.6 mg/kg, and intubation was conducted when BIS decreased lower than 60 and mean arterial pressure (MAP) 0.05) . The pre-opertaive cTnI, CK, CK-MB and LAC were within the normal range, but increased siginicantly on T2, T3 and T4, and was more significant on T3 ( < 0.01) between two groups, and the intra-group comparison showed no difference on other time points. Conclusion When myocardial injury markers used as myocardial protection outcome variables, whole sevoflurane inhaling could not reduce the release of cTnI compared to propofol TIVA in heart valve replacement surgery.
Résumé
ObjectiveTo investigate the clinical efficiency of oral warfarin after cardiac valve replacement and the influence of vitamin K epoxide reductase complex subunit 1(VKORC1) gene polymorphisms on warfarin maintenance dose.MethodsOne hundred and fifty-nine patients who got cardiac valve replacement surgery were chosen and received anticoagulation therapy by oral warfarin.The prothrombin time (PT),international normalized ratio (INR) of patients were recorded and the safety ranges of PT and INR were calculated statistically.VKORC1 gene polymorphism of patients weredetected by PCR-PFLP technology by adjusting the dose of warfarin,and the results were compared.ResultsThe safety monitoring range of PT of oral warfarin after cardiac valve replacement surgery was 15.36 -24.82 s,safety monitoring range of INR was 1.33 - 2.62.The occurrence rate of bleeding during anticoagulation was 13.21％(21/159).The weekly dose of warfarin of VKORC1 gene type AA [(24.28 ± 10.79) mg] was significantly higher than that of VKORC1 gene type GA[ ( 16.64 ± 7.43 ) mg] and type GG[ ( 12.12 ± 7.17 ) mg](P＜ 0.05or ＜0.01 ).ConclusionsThe polymorphism of VKORC1 gene is the dominant factor of the differences of warfarin maintenance dose.The warfarin dose in patients with different gene type is different.The clinical safety monitoring ranges of PT and INR in patients with oral warfarin after cardiac valve replacement are lower than the recommended ranges of European and American countries.Therefore,the index of patients after surgery should be detected regularly.