Changes Of The Renin-angiotensin-aldosterone Sysetem During The Perioperative Period In Patients With Mitral Valve Replacement Its Clinical Significance

Objective: TO investigate the elinical significance and changes ofrenin-angiotensin-aldosterone syetem during the perioperative periodinpatients with mitral valve replacement.Methods: The study enrolled20patients with mitral stenosis and24patients with mitral stenosis with mitral incompetence.20normal subjectswere selected as normal control(NC) group.Used elisa for testing the plasmarenin,angiotensin(Ang)Ⅱ and aldosterone(Ald) levels in patients cured byvalve repacement preperatively(T1),after anesthesia induction(T2),at the endof CPB(T3),immediately plstoperatively(T4) and the24hours(T5),48hours(T6),72hours(T7),5th day(T8) after the operation,respectively.Results:1.The plasma PRA, Ang Ⅱ, Ald levels in cases of mitral stenosis ormitral stenosis with mitral incompetence were significantly higher than that ofnormal control group(p＜0.01).and there was no statistically significantdifference between the mitral stenosis and mitral stenosis with mitralincompetence group(p＞0.05).2.Patients with mitral stenosis group:Circulating PRA, Ang Ⅱ, Aldlevels increased significantly compared with preoperative after anesthesiainduction(T2) or at the end of CPB(T3)(p＜0.05).in the immediatepostoperative period began to decline,but still higher than preoperative（P＜0.05），and the levels of PRA, Ang Ⅱ, Ald dropped to normal gradually After 24hours to5days postoperatively。Patinents with mitral stenosis with mitral incompetence group:Circulating PRA, Ang Ⅱ, Ald levels increased significantly compared withpreoperative after anesthesia induction(T2) or at the end of CPB(T3)(p＜0.05).in the immediate postoperative period began to decline,but still higherthan preoperative（P＜0.05）,the levels of PRA, Ang Ⅱ, Ald were alwaysclosed to that of preoperative After24hours to72hours postoperatively（P>0.05）.3.In T1、T2、T3、T4，group A and group B at the same time is nodifference(P＞0.05）；and in T5、T6、T7、T8，PRA, Ang Ⅱ, Ald level groupB is significantly higher than group A（P＞0.05）.Conclusions:1.Patients with mitral valve disease is characterized by the activation ofRAAS system.2.The levels of RAAS changed in different time point.Thechanged trend of Patients with mitral stenosis group and Patinents with mitralstenosis with mitral incompetence group are not identical.3.Its was necessaryto use ACEI preoperatively in case of mitral stenosis or mitral stenosis withmitral incompetence,and its better to use ACEI during the early postoperativeperiod in case of mitral stenosis with mitral incompetence.