ObjectiveTo investigate the perioperative change of parathyroid hormone (PTH) and its effect on cardiac function in patients with rheumatic heart disease.MethodsFrom January 2018 to June 2019, 76 patients were randomly divided into calcium supplement group (n=39) and control group (n=37). Mitral valve replacement was performed in both groups with cardiopulmonary bypass (CPB). Blood gas was measured immediately and every 6 h within 24 h after CPB. The patients in the calcium supplement group were given 1 g of calcium gluconate when hypocalcemia occurred, while the control group received no calcium supplementation. Values of radial arterial blood PTH and calcium ion (Ca2+) were measured in the two groups before operation (T1), at 30 min after starting CPB (T2), immediately after stopping CPB (T3), at 24 h after operation (T4), and at 48 h after operation (T5), respectively.ResultsThere were 71 patients enrolled in this study finally, including 38 in the calcium supplement group and 33 in the control group. The PTH values of patients in the two groups gradually increased, reached the peak at T3 time-point, then began to recover gradually. There was no significant difference between the two groups at T1, T2 or T3 time-point (P>0.05), while there were significant differences at T4 and T5 time-points (P<0.05). The Ca2+ values of the two groups gradually decreased after CPB, and gradually increased after blood ultrafiltration. There was no significant difference between the two groups at T1 or T3 time-point (P>0.05), while there were significant differences at T2, T4 and T5 time-points (P<0.05). The postoperative 24-hour values of ejection fraction (EF) and cardiac troponin T (cTnT) and the 72-hour total amount of epinephrine used in the calcium supplement group were (42.66±4.18)%, (1 881.17±745.71) ng/L, and (3.04±0.86) mg, respectively, and those in the control group were (40.76±3.39)%, (2 725.30±1 062.50) ng/L, and (4.69±1.37) mg, respectively. There were statistically significant differences in EF, cTnT and the 72-hour total amount of epinephrine used between the two groups (P<0.05). Values of PTH at T4 and T5 time-points were respectively negatively correlated with postoperative 24-hour value of EF (r=-0.324, P=0.006; r=-0.359, P=0.002), positively correlated with postoperative 24-hour value of cTnT (r=0.238, P=0.046; r=0.248, P=0.037) and the 72-hour total amount of epinephrine used (r=0.324, P=0.006; r=0.383, P=0.001).ConclusionsHyperparathyroidism occures after CPB, and calcium supplementation could relieve the hyperparathyroidism. Hyperparathyroidism may be related to postoperative cardiac insufficiency.
【摘要】 目的 了解心臟瓣膜置換術后認知功能障礙（POCD）的危險因素，明確圍手術期腦糖代謝異常是否為術后POCD的可能發病機制之一。 方法 選取2004年3月-2009年7月心臟瓣膜置換術患者70例，根據術后第7天患者認知功能測定結果分為POCD組（n =31）和非POCD組（n =39），比較兩組患者年齡、性別、體外循環（CPB）時間、主動脈阻斷時間、主動脈阻斷后平均動脈壓和平均灌注流量，并且分別于麻醉后手術前（T1）、CPB穩定的低溫期（T2）、復溫至33℃（T3）、CPB結束后30 min（T4）4個時點采動脈及頸內靜脈血，測定血氣、血糖濃度，計算出腦攝氧率（CEO2）、腦糖攝取Glu（a-v）。 結果 發生POCD的患者年齡較非POCD組大，并且CPB時間和主動脈阻斷時間也更長，兩組之間比較有統計學差異（Plt;0.05），但是兩組在性別、主動脈阻斷后平均動脈壓和平均灌注流量比較無統計學差異。兩組的CEO2變化趨勢一致，各時點的值無明顯變化，兩組間比較無差異；非POCD組的Glu（a-v）各時點間比較無統計學差異，POCD組的Glu（a-v）T1、T2時點也無明顯變化，但POCD組的Glu（a-v）在T3、T4明顯降低，并且與非POCD組比較有統計學意義（Plt;0.05）。 結論 年齡、CPB時間和主動脈阻斷時間是POCD發生的危險因素。腦糖代謝異常是POCD發生的可能機制之一。【Abstract】 Objective To understand the risk factor of postoperative cognitive dysfunction (POCD), and identify whether perioperative brain glucose metabolism disorder was or not pathogenesis of POCD after heart valve replacement operation. Methods From March 2004 to July 2009, 70 patients with heart valve replacement were divided into POCD group (n=31) and non-POCD group (n=39) according to cognitive function status tested on the seventh day after operation. The age, sex, cardiopulmonary bypass (CPB) duration, aortic crossclamp duration, mean arterial blood pressure and mean priming volume after aortic crossclamp of two groups were compared. Blood samples were drawn from the radial artery and jugular bulb catheters for determination of blood gas and glucose after induction of anaesthesia (baseline), at the time of the lowest CPB temperature, rewarming to 33℃, and 30 minutes after termination of CPB, CEO2 and Glu (a-v) were calculated: CEO2= (CaO2－CvO2) /CaO2. Results In POCD group, the average age was larger and CPB duration and aortic crossclamp duration was longer than in non-POCD group (Plt;0.05) , but there were no statistical differences in sex, mean arterial blood pressure and mean priming volume after aortic crossclamp. The change tendency of CEO2 of two groups were similar and without significant difference. Glu (a-v) of non-POCD group had no difference in every point, and Glu (a-v) of POCD group had no difference in T1 and T2 points, but value of Glu (a-v) of POCD group decreased obviously and had distinct difference with that of non-POCD group in T3 and T4 points (Plt;0.05). Conclusion Age, CPB duration, and aortic crossclamp duration were risk factors of POCD. Brain glucose metabolism disorder was possibly one of pathogenesis of POCD.