本文選題：芪參益氣滴丸　切入點(diǎn)：藥物預(yù)處理　出處：《第三軍醫(yī)大學(xué)》2014年碩士論文

【摘要】：背景及目的： 目前對(duì)體外循環(huán)下心臟瓣膜置換手術(shù)患者心肌保護(hù)的研究很多，但多集中在心肌停搏液及各種添加劑的研究，本研究旨在探討現(xiàn)代中藥制劑芪參益氣滴丸(Qishen Yiqi Pills)預(yù)處理對(duì)體外循環(huán)下心臟瓣膜置換手術(shù)患者的心肌保護(hù)以及對(duì)右室心臟功能的影響。 方法： 將我院心血管外科2012年5月-2013年5月間，需在體外循環(huán)下行瓣膜置換手術(shù)的患者120例隨機(jī)分為兩組：對(duì)照組（A組）60例和芪參組（B組）60例。術(shù)前：對(duì)照組常規(guī)治療基礎(chǔ)上，應(yīng)用芪參益氣滴丸安慰劑，餐后半小時(shí)服用，每次藥物量為0.5g，每日3次，持續(xù)至研究結(jié)束；芪參組在常規(guī)治療的基礎(chǔ)上,應(yīng)用芪參益氣滴丸，餐后半小時(shí)服用，每次藥物量為0.5g，每日3次，持續(xù)至研究結(jié)束。在麻醉前（T0）及主動(dòng)脈開放后12h(T1)和24h(T2)兩組患者分別抽血檢測(cè)血清心肌損傷標(biāo)志物磷酸肌酸酶同工酶（CK-MB）和肌鈣蛋白I（nTnI）。于術(shù)前及術(shù)后第1周、第6周分別測(cè)量?jī)山M患者右室射血分?jǐn)?shù)(RVEF)、右心室輸出量(RVSV)、右心室舒張期末容積(RVEDV)和右心室收縮期末容積(RVESV)。并記錄手術(shù)時(shí)體外循環(huán)時(shí)間、輔助循環(huán)時(shí)間、升主動(dòng)脈阻斷時(shí)間，，開放升主動(dòng)脈后心臟自動(dòng)復(fù)跳情況、體外循環(huán)停止后多巴胺用量、心律失常發(fā)生情況、術(shù)后停留監(jiān)護(hù)室（ICU）時(shí)間。 結(jié)果： 1.兩組患者的體外循環(huán)時(shí)間、輔助循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間的比較無顯著差異性（P0.05）；B組心律失常發(fā)生率低于A組，兩組患者的心律失常均為陣發(fā)性房顫，但在統(tǒng)計(jì)學(xué)上無顯著差異性（P0.05）。 2.兩組患者升主動(dòng)脈開放后B組14例患者除顫心臟復(fù)跳，明顯低于A組32例，兩組心臟復(fù)跳情況比較存在顯著差異（P0.05）。體外循環(huán)停止后平均多巴胺使用量A組平均在4.0±0.8μg/kg min，明顯高于B組2.1±1.4μg/kg min，比較有顯著差異(P0.05)�；颊咴贗CU病房的時(shí)間A組4.2±1.3d，高于B組2.5±0.9d，比較有顯著差異（P0.05）。術(shù)后兩組患者cTnl濃度的是呈上升趨勢(shì)，術(shù)后24小時(shí)A組cTnl為1.58±0.34ng/ml,B組cTnl為1.03±0.22ng/ml，兩者比較有顯著差異（P0.05）。術(shù)后兩組患者CK-MB濃度升高，術(shù)后12小時(shí)A組CK-MB為26.89±5.04U/L,B組CK-MB為17.32±6.01U/L，于術(shù)后24小時(shí)A組CK-MB為22.36±5.37U/L,B組CK-MB為14.13±5.28U/L，兩者比較均有顯著差異（P0.05）。 3.手術(shù)前兩組患者右心室舒張期末容積(RVEDV)、右心室收縮期末容積(RVESV)、右心室輸出量(RVSV)及射血分?jǐn)?shù)（RVEF）比較無明顯差異性（P0.05）；手術(shù)后第1周及第6周時(shí)兩組患者心臟超聲顯示右心室舒張期末容積(RVEDV)、右心室收縮期末容積(RVESV)、右心室輸出量(RVSV)較術(shù)前均明顯降低，而射血分?jǐn)?shù)（RVEF）較術(shù)前明顯升高，但B組術(shù)后右心室舒張期末容積(RVEDV)、右心室收縮期末容積(RVESV)、右心室輸出量(RVSV)降低程度顯著低于A組,差異具有統(tǒng)計(jì)學(xué)意義（P0.05)，而射血分?jǐn)?shù)（RVEF）B組升高程度顯著高于A組，差異具有統(tǒng)計(jì)學(xué)意義（P0.05)。結(jié)論： 心臟瓣膜病患者術(shù)前常規(guī)治療基礎(chǔ)上加用芪參益氣滴丸，可以增強(qiáng)心肌細(xì)胞抗缺氧能力，減少體外循環(huán)過程中缺血再灌注損傷的并發(fā)癥,對(duì)改善術(shù)后患者右室心臟功能，促進(jìn)術(shù)后恢復(fù)具有重要作用，對(duì)于體外循環(huán)下進(jìn)行瓣膜置換手術(shù)后出現(xiàn)的心力衰竭的治療開辟了新的途徑，值得臨床推廣。
[Abstract]:Background and Purpose :

At present , there are many researches on myocardial protection in patients undergoing heart valve replacement under extracorporeal circulation , but it is focused on the study of cardiac arrest fluid and various additives . The purpose of this study is to discuss the effect of Qishen Yiqi dripping pill ( Qishen Yiqi dripping pill ) preconditioning on myocardial protection and right ventricular function in patients undergoing heart valve replacement during cardiopulmonary bypass .

Method :

The cardiovascular surgery in our hospital from May 2012 to May 2013 was divided into two groups : control group ( group A ) and Qishen group ( group B ) in 60 cases .
Serum myocardial injury markers ( RVEF ) , right ventricular output ( RVSV ) , right ventricular end - diastolic volume ( RVEDV ) and right ventricular end - systolic volume were measured before and after anesthesia ( T0 ) and 12 h ( T1 ) and 24 h ( T2 ) .

Results :

1 . There was no significant difference in the cardiopulmonary bypass time , the auxiliary circulation time and the aortic cross - blocking time between the two groups ( P0.05 ) .
The incidence of arrhythmia in group B was lower than that in group A . The arrhythmias in both groups were paroxysmal atrial fibrillation , but there was no statistically significant difference ( P0.05 ) .

There was a significant difference between the two groups ( P < 0.05 ) . The levels of serum CK - MB in group B were significantly higher than those in group B ( P < 0.05 ) . The levels of serum CK - MB in group B were significantly higher than those in group B ( P < 0.05 ) . The levels of CK - MB in group B were significantly higher than those in group B ( P < 0.05 ) .

3 . There was no significant difference between the right ventricular end - diastolic volume ( RVEDV ) , the end - of - end volume of the right ventricle ( RVSV ) , the right ventricular output ( RVSV ) and ejection fraction ( RVEF ) in the two groups before surgery ( P0.05 ) .
At the 1st and 6th weeks after surgery , the right ventricular end - diastolic volume ( RVEDV ) , the end - of - systolic volume of the right ventricle ( RVET ) and the right ventricular output ( RVSV ) were significantly lower than those in group A ( P0.05 ) .

Qi Shen Yiqi dripping pill can be added on the basis of conventional treatment before operation of patients with valvular heart disease , so that the anti - anoxia ability of the myocardial cells can be enhanced , the complications of ischemia reperfusion injury in the process of cardiopulmonary bypass are reduced , the function of the right ventricle of the right ventricle of the patient after operation is improved , the postoperative recovery is important , and a new approach is opened for the treatment of heart failure after the valve replacement surgery under extracorporeal circulation , and is worthy of clinical popularization .

【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R259

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