| ObjectiveTo investigate the dynamic changes of the PEF and explore effects of the glucocorticoid on it’s changes in the patients during rheumatic valve replacemental perioperation. Methods180 patients with rheumatic heart disease undergoing valve replacement were randomly allocated into two groups: group A(the study group, n=90) and group B(the control group, n=90). Two groups were each divided into 3 groups(II,III,IV grade cardiac function)according to NYHA heart function classification and each group was divided into 3 groups(under 40 years,40-60 years,over 60 years old)by the age within the group. Two groups were both respectively given 1000 mg methylprednisolone during extracorporeal circulation, while only the group A were intravenously injected with 10 mg glucocorticoid on the first three postoperative days and the group B without any additional medication intervention. The enzyme-linked immunosorbent assay(ELISA) was taken to detect the serum cortisol concentration at 7 in the morning, the 24-hour urine cortisol and the PEF was measured at 4 O’clock in the afternoon by Keka PEF-3 detector during the 1st,3rd, 5th, and 7th day after surgery, the dynamic changes of PEF value and the patients’ recovery were investigated at the corresponding time. Result1. 72 patients failed to timely detect PEF on the first pastoperative day, in addition, remaining 108 cases were successfully completed according to the corresponding time. There are 22 cases in NYHA-II cardiac function, 51 cases in NYHA-III cardiac function and 17 cases in NYHA-IV cardiac function within group A; 12 cases are under 40 years, 58 cases are between 40~60 years, and 20 cases are more than 60 years in group A; There are 14 cases in NYHA-II cardiac function, 48 cases in NYHA-III cardiac function and 28 cases in NYHA-IV cardiac function within group A; 14 cases are under 40 years, 50 cases are between 40~60 years, and 26 cases are more than 60 years in group A. All enrolled patients were successfully completed the measurement of cortisol concentration in serum and 24-hour urinary cortisol; 148 cases succeeded in pulling out tracheal intubation on the 1th postoperative day, while 32 cases failed to pulling out tracheal intubation; There were 10 patients with pulmonary infection during the rheumatic valve replacemental perioperation, of which 2 cases occurred in the group A and the other 8 cases in group B; All the patients were rehabilitation discharge, no one died, and no one had complications such as deadly pulmonary infection or incisions healing problems.2. Changes of PEF during the perioperative period:PEF shows a down-and-up trend during the perioperative period, d3 was lowest and gradually increased after d3, finally come back to preoperative level in d5. In the different cardiac function and age groups, dynamic changes of perioperative PEF are consistent with the overall trend.3. Effects of glucocorticoid on the perioperative changes of PEF: Changes of PEF in the study group with glucocorticoid intervented was similar to that in the control group, PEF shows a down-and-up trend during the perioperative period, d3 was lowest and gradually increased after d3, finally come back to preoperative level in d5.It is no statistically significant difference in PEF between group A and group B with different cardiac function in d0,d3(P>0.05), but PEF in d5,d7 in group A are higher than group B, and the statistically difference is significant(P<0.05).what’s more, PEF in NYHA-IV group within group A are higher than preoperative levels in d5,d7, but no statistically significant difference(P>0.05).The statistical difference in PEFduring d0,d3 with glucocorticoid intervented was no significant between two groups(P>0.05). D5,d7,PEF of the patients under 60 years in group A were higher than group B, and the statistical difference was significant(P<0.05), while, PEF in the patients over 60 is no statistically significant difference between group A and group B during perioperative period(P>0.05).4. Dynamic changes of Plasma cortisol concentration during the periperative period: Changes of plasma cortisol concentration also shows a down-and-up trend during perioperation,d0~d3 plasma cortisol falls to the bottom and rises gradually; d1(323.76±260.61), d3(269.93±226.59)are lower than d0(433.70±115.60)(P<0.05), the plasma cortisol level return to preoperation in d5.5. Effects of glucocorticoid on the perioperative changes of plasma cortisol concentration: The dynamic changes of cortisol levels in group A are similar to group B. d0(416.20±120.40) was higher than d1(306.63±243.11),d3(254.10±182.10)(P<0.05).It’s no statistically significant difference compared d0 with d5 and d7. Cortisol levels between group A and group B in the corresponding times are no statistically significant difference.6. Changes of 24-hour urinary cortisol and effects of glucocorticoid on it: Regardless of using glucocorticoids or not, d1 is much higher than d0 in two group(P<0.01), but d3, d5, d7 seem no statistically significant difference compared with d0 between group A and group B. Conclusion1. PEF and plasma cortisol concentration in patients with intracardiac rheumatic valve replacement show a down-and-up trend, the levels on the 3rd day after operation fall to the lowest, finally come back to preoperative level on the 5th day after operation.2. Using glucocorticoid in the first three days after surgery doesn’t disturb the overall trend of perioperative PEF changes. but it could significantly improve the PEF value on the 5th day and 7th day after operation.3. The effect of glucocorticoids on plasma cortisol concentration was very little, and the serum cortisol levels were not statistically different at each corresponding date time point compared group A with group B.4. Glucocorticoids not only did not increase pulmonary infection and incision infection, but also can impove the PEF value of the 5th day and 7th day after operation. Therefore, we advocate that glucocorticoid should be used in patients during rheumatic valve replacemental period from the perspective of improving pulmonary function. |
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