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三尖瓣反流表现为三尖瓣或三尖瓣环结构上的异常,导致一部分血流从右心室反流回右心房,通常由原发性或肺动脉高压、房颤、左心瓣膜疾病导致的继发性功能障碍所致[1]。手术是目前治疗三尖瓣重度反流的最佳选择[2]。胃肠功能障碍是心胸外科手术患者术后常见并发症,且早期胃肠功能障碍患者更容易出现术后机械通气时间延长、重症监护室(ICU)住院时间延长等问题[3]。胃肠动力药是促进患者术后胃肠功能恢复的常见用药,能有效缓解患者术后消化功能紊乱症状。笔者选择2011年1月至2021年12月海军军医大学第一附属医院心血管外科收治的184例三尖瓣重度反流患者,观察并分析术后3 d内预防性使用胃肠动力药在体外循环下三尖瓣置换术患者的临床治疗效果,现报告如下。
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在纳入研究的184例重度三尖瓣反流患者中,有101例患者(54.89%)术后3 d服用胃肠动力药,其中,72例患者(39.13%)术后服用莫沙必利,36例患者(19.57%)术后服用多潘立酮,7例患者(3.80%)同时服用莫沙必利和多潘立酮;83例患者(45.11%)术后3 d内未服用胃肠动力药。两组患者在年龄、性别、BMI、疾病史、手术史均无统计学差异(P>0.05),见表1。
表 1 两组患者一般资料比较
项目 预防组 对照组 χ2(Z)值 P值 年龄 (岁) 56.0 [51.0,67.0] 59.0[49.0,65.0] −0.039 0.970 男性[n (%)] 40 (39.6) 36 (43.4) 0.267 0.653 BMI (kg/m2) 22.5 [20.4,24.0] 21.7 [19.0,23.9] −1.744 0.081 糖尿病[n (%)] 8 (7.9) 6 (7.2) 0.031 1.000 高血压[n (%)] 12 (11.9) 8 (9.6) 0.237 0.645 肝硬化[n (%)] 3 (3.0) 4 (4.8) 0.426 0.703 肾功能不全[n (%)] 3 (3.0) 1 (1.2) 0.668 0.628 脑卒中史[n (%)] 5 (5.0) 8 (9.6) 1.525 0.256 心脏手术史[n (%)] 79 (78.2) 57 (68.7) 2.152 0.177 -
预防组患者术后平均首次排便时间为3.32 d,低于对照组患者术后平均首次排便时间4.67 d。预防组患者中排便延迟的发生率为40.1%,显著低于对照组患者排便延迟发生率65.1%,差异均具有统计学意义(P<0.05),见表2。
表 2 两组患者首次排便时间比较
项目 预防组 对照组 χ2(Z)值 P值 排便时间 (t/d) 3.0[2.0,4.0]*** 4.0[3.0,5.0] −3.634 <0.001 排便延迟[n (%)] 41 (40.6)** 54 (65.1) 10.920 0.001 **P<0.01,***P<0.001,与对照组比较。 -
预防组患者腹胀症状发生率明显低于对照组患者,差异具有统计学意义(P<0.05),其他胃肠功能障碍未见统计学差异(P>0.05),见表3。
表 3 两组患者胃肠功能障碍发生情况比较
项目 预防组[n (%)] 对照组[n (%)] χ2(Z)值 P值 恶心 11 (10.9) 10 (12.0) 0.060 0.820 呕吐 9 (17.8) 5 (6.0) 0.540 0.581 腹胀 2 (2.0)* 8 (9.6) 5.199 0.045 腹泻 3 (3.0) 6 (7.2) 1.776 0.303 消化道出血 4 (4.0) 3 (3.6) 0.015 1.000 *P<0.05,与对照组比较。 -
预防组患者肺部感染发生率显著低于对照组患者(P<0.05),其余术后并发症未见统计学差异(P>0.05)。此外,预防组患者ICU时长、气管插管时长、胃管置入时长均短于对照组患者,差异具有统计学意义(P<0.05),见表4。
表 4 两组患者预后及并发症比较
项目 预防组 对照组 χ2(Z)值 P值 死亡[n (%)] 6 (5.9) 9 (10.8) 1.463 0.283 心功能不全[n (%)] 4 (4.0) 3 (3.6) 0.015 1.000 肾衰[n (%)] 5 (5.0) 10 (12.0) 0.080 0.105 肺部感染[n (%)] 5 (5.0)* 12 (14.5) 4.911 0.039 癫痫/脑卒中[n (%)] 3 (3.0) 4 (4.8) 0.426 0.703 ICU时长 (t/h) 100.0[25.5,85.0]* 176.5[43.0,119.0] −2.190 0.028 气管插管时长 (t/h) 41.0[7.0,21.5]** 126.0[15.0,44.0] −3.127 0.002 胃管置入时长(t/h) 67.0[10.5,26.0]** 143.0[17.0,82.0] −3.191 0.001 *P<0.05,**P<0.01,与对照组比较。
Observation of the prophylactic use of prokinetic agents in patients after tricuspid valve replacement under cardiopulmonary bypass
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摘要:
目的 对体外循环下行三尖瓣置换术后患者服用胃肠动力药的治疗效果进行临床分析。 方法 选取2010年6月至2021年12月在海军军医大学第一附属医院心血管外科接受体外循环下三尖瓣置换术的患者作为研究对象,收集并回顾性分析术后3 d内,服用胃肠动力药(预防组)与未服用胃肠动力药(对照组)患者的基线资料、术后首次排便时间和术后恢复情况。 结果 筛选患者184例,其中,预防组101例,对照组83例。预防组患者首次排便时间明显早于对照组患者排便时间(P<0.05),预防组患者腹胀、肺部感染的概率明显低于对照组患者,且预防组患者ICU时长、术后机械通气时长、胃管置入时长明显短于对照组患者(P<0.05)。 结论 术后3 d内服用胃肠动力药能有效改善体外循环下三尖瓣置换术患者预后。 Abstract:Objective To analyze the postoperative therapeutic effect of prokinetic agents in patients after tricuspid valve replacement (TVR) under cardiopulmonary bypass. Methods Patients received TVR under cardiopulmonary bypass (during June 2010 to December 2021) in the department of Cardiovascular Surgery of the First Affiliated Hospital of Naval Medical University were selected as the subjects of our study. The data of basic characteristics, first postoperative defecation time and postoperative recovery condition were collected and retrospectively analyzed in the patients taking prokinetic agents within three days after surgery (prevention group) and patients not taking prokinetic agents within three days after surgery (control group). Results A total of 184 patients were selected, including 101 in the prevention group and 83 in the control group. The first defecation time of patients in the prevention group was significantly earlier than that in the control group (P<0.05). The incidences of abdominal distension and pulmonary infection in the prevention group were significantly lower than that in the control group. The length of time in ICU, postoperative mechanical ventilation and nasogastric tube decompression in the prevention group were significantly shorter than that in the control group (P<0.05). Conclusion Taking prokinetic agents within three days after TVR under cardiopulmonary bypass could effectively improve the prognosis of patients. -
Key words:
- prokinetic agents /
- tricuspid valve replacement /
- clinical effect /
- retrospective study
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表 1 两组患者一般资料比较
项目 预防组 对照组 χ2(Z)值 P值 年龄 (岁) 56.0 [51.0,67.0] 59.0[49.0,65.0] −0.039 0.970 男性[n (%)] 40 (39.6) 36 (43.4) 0.267 0.653 BMI (kg/m2) 22.5 [20.4,24.0] 21.7 [19.0,23.9] −1.744 0.081 糖尿病[n (%)] 8 (7.9) 6 (7.2) 0.031 1.000 高血压[n (%)] 12 (11.9) 8 (9.6) 0.237 0.645 肝硬化[n (%)] 3 (3.0) 4 (4.8) 0.426 0.703 肾功能不全[n (%)] 3 (3.0) 1 (1.2) 0.668 0.628 脑卒中史[n (%)] 5 (5.0) 8 (9.6) 1.525 0.256 心脏手术史[n (%)] 79 (78.2) 57 (68.7) 2.152 0.177 表 2 两组患者首次排便时间比较
项目 预防组 对照组 χ2(Z)值 P值 排便时间 (t/d) 3.0[2.0,4.0]*** 4.0[3.0,5.0] −3.634 <0.001 排便延迟[n (%)] 41 (40.6)** 54 (65.1) 10.920 0.001 **P<0.01,***P<0.001,与对照组比较。 表 3 两组患者胃肠功能障碍发生情况比较
项目 预防组[n (%)] 对照组[n (%)] χ2(Z)值 P值 恶心 11 (10.9) 10 (12.0) 0.060 0.820 呕吐 9 (17.8) 5 (6.0) 0.540 0.581 腹胀 2 (2.0)* 8 (9.6) 5.199 0.045 腹泻 3 (3.0) 6 (7.2) 1.776 0.303 消化道出血 4 (4.0) 3 (3.6) 0.015 1.000 *P<0.05,与对照组比较。 表 4 两组患者预后及并发症比较
项目 预防组 对照组 χ2(Z)值 P值 死亡[n (%)] 6 (5.9) 9 (10.8) 1.463 0.283 心功能不全[n (%)] 4 (4.0) 3 (3.6) 0.015 1.000 肾衰[n (%)] 5 (5.0) 10 (12.0) 0.080 0.105 肺部感染[n (%)] 5 (5.0)* 12 (14.5) 4.911 0.039 癫痫/脑卒中[n (%)] 3 (3.0) 4 (4.8) 0.426 0.703 ICU时长 (t/h) 100.0[25.5,85.0]* 176.5[43.0,119.0] −2.190 0.028 气管插管时长 (t/h) 41.0[7.0,21.5]** 126.0[15.0,44.0] −3.127 0.002 胃管置入时长(t/h) 67.0[10.5,26.0]** 143.0[17.0,82.0] −3.191 0.001 *P<0.05,**P<0.01,与对照组比较。 -
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