Study On The Perioperative Changes Of Free Ca²⁺,PTH,CT And Mg²⁺ In Patients With Rheumatic Heart Disease

Objective:In this paper,to explore the connection of free Ca²⁺,parathyroid hormone,Mg²⁺and calcitonin in perioperative period of patients with rheumatic heart disease,so as to provide theoretical basis for the treatment of perioperative hypocalcemia of rheumatic heart disease.Methods:In this study,to select 36 patients with rheumatic heart disease randomly divided into A?B two groups who needed open heart surgery under moderate hypothermia cardiopulmonary bypass?CPB?in Chengdu second people's hospital.Group A?n=20?:calcium gluconate 2g was added for the first time when extracorporeal circulation?T3?was shut down,and free calcium was monitored every 6 hours thereafter.Calcium gluconate 1g was added if hypocalcemia occurred.Group B?n=16?:no calcium supplements were given at each time point and no severe hypocalcemia causing clinical symptoms was found in 36subjects.All patients underwent surgery in the situation of intravenous anesthesia,moderate dilution of blood and moderate hypothermia.We extracted 4ml of blood from the radial artery of all patients to measure and record the concentrations of free Ca²⁺,parathyroid hormone,Mg²⁺and calcitonin at the 5 time points?preanesthesia?T1?,cardiopulmonary bypass begins for 30 minutes?T2?,the time point of cardiopulmonary bypass shutdown?T3?,24h after surgery?T4?,48h after surgery?T5??,record the amount and time of vasoactive agent after operation in group A and group B.Results:In patients with rheumatic heart disease,comparison results of general data and surgical conditions between group A and group B:Group A:6 males and 14 females,average?59.30±7.93?years;Group B:4 males and 12 females,average?60.06±9.41?years;The cardiac function of all patients was in level II-III?NYHA?.There was no significant difference in disease structure and surgical conditions between group A and B.In patients with rheumatic heart disease,Group A:There were no significant differences to compare the concentration of PTH at the time points between T4 and T1?P>0.05?,the other time points of concentration of PTH was significantly different from the previous time point?P<0.05?.Group B:There were no significant differences to compare the concentration of PTH at the time points between T5 and T4?P>0.05?,the other time points of concentration of PTH was significantly different from the previous time point?P<0.05?.The comparison between groups A and B:there were no significant difference to compare the concentration of PTH at the time points of T1,T2 and T3?P>0.05?;there was significant difference to compare the concentration of PTH at T4 time point between group A and group B?P<0.05?;there was significant difference to compare the concentration of PTH at T5 time point between group A and group B?P<0.05?.In patients with rheumatic heart disease,Group A:There were no significant differences to compare the concentration of free Ca²⁺at the time points between T5 and T3,T4 and T3,T5 and T4?P>0.05?,the other time points of concentration of free Ca²⁺was significantly different from the previous time point?P<0.05?.Group B:At each time point,the next time point of concentration of free Ca²⁺was significantly different from the previous time point?P<0.05?.The comparison between groups A and B:there were no significant difference to compare the concentration of free Ca²⁺at the time points of T1,T2and T3?P>0.05?;there was significant difference to compare the concentration of free Ca²⁺at T4 time point between group A and group B?P<0.05?;there was significant difference to compare the concentration of free Ca²⁺at T5 time point between group A and group B?P<0.05?.In patients with rheumatic heart disease,Group A:there were no significant differences to compare the concentration of Mg²⁺at the time points between T2 and T3,T4and T5?P>0.05?,the other time points of concentration of Mg²⁺was significantly different from the previous time point?P<0.05?.Group B:there were no significant differences to compare the concentration of Mg²⁺at the time points between T2 and T3,T4 and T5?P>0.05?,the other time points of concentration of Mg²⁺was significantly different from the previous time point?P<0.05?.The comparison between groups A and B:There was no significant difference to compare the concentration of Mg²⁺at each time point between group A and group B?P>0.05?.In patients with rheumatic heart disease,the perioperative concentration of CT in peripheral blood of group A and group B were far lower than the upper limit of the normal range at each time point,and their changes can not affect the change of free Ca²⁺,PTH and Mg²⁺.There was no significant difference to compare the concentration of CT at each time point in group A?P>0.05?.There was no significant difference to compare the concentration of CT at each time point in group B?P>0.05?.There was no significant difference to compare the concentration of CT at each time point between group A and group B?P>0.05?.In patients with rheumatic heart disease,There were significant differences in the usage amount and time of epinephrine after operation in groups A and B?P<0.05?.There was a significant difference in the usage time of nitroglycerin after operation between groups A and B?P<0.05?.There was no significant difference in the usage amount of milinone,isoproterenol,dopamine and nitroglycerin after operation between group A and group B?P>0.05?.There was no significant difference in the usage time of milinon,isoproterenol and dopamine after operation between groups A and B?P>0.05?.Conclusion:?1?In patients with rheumatic heart disease,PTH and free Ca²⁺increased gradually after the beginning of extracorporeal circulation,free Ca²⁺decreased at T2 time point,PTH continued to increase,and the two separated,and both showed a decreasing trend after T3 time point.?2?Postoperative calcium supplementation in patients with rheumatic heart disease can not only inhibit the secretion of PTH,but also reduce the usage amount of adrenalin and shorten its use time.