| Objective:Pulmonary hypertension?PH?is a common complication of cardiopulmona ry bypass?CPB?in patients with heart disease,which affects the patient's early smo oth passage and has adverse effects on prognosis.This article analyzes and compares the pulmonary oxygenation indexes of patients with elevated pulmonary artery pres sure and normal pulmonary artery pressure after valvular heart disease?VHD?after surgery:oxygenation index?OI?,arterial-alveolar oxygen fraction,alveolar-arterial ox ygen tension gradient?P?A-a?O2?,respiratory index?RI?,interleukin-6?IL-6?,the incid ence of related complications,reflecting the adverse effects of secondary PH on pul monary oxygenation,and to analyze the preoperative risk factors of secondary PH.Methods:Forty-four patients?preoperative pulmonary systolic blood pressure<50mmH g?with VHD who underwent open-heart surgery under CPB in the Department of Thoracic and Cardiovascular Surgery of Chengdu Second People's Hospital.Immedia tely after the operation,systolic pulmonary artery pressure?SPAP?was measured by transthoracic echocardiography.SPAP?30mmHg was divided into group A?n=21?an d SPAP>30mmHg was divided into group B?n=23?.At the following time points:before operation?T0?,end of operation?T1?,24h after operation?T2?,72h after operati on?T3?,patients were collected artery blood and measured SPAP by transthoracic ec hocardiography.OI,RI,P?A-a?O2 and arterial-alveolar oxygen fraction calculated by blood gas analysis.IL-6 was detected with CLIA at all the time points.Results:1.There was no significant difference in age,gender,body mass index,preoperative SPAP,and preoperative creatinine.The left ventricular ejection fraction?LVEF?between the two groups was statistically significant.2.No adverse reaction to protamine occurred in both groups.There was no significant difference in the surgical method and autologous blood,.The operation time?aortic occlusion time and cardiopulmonary bypass time were statistically significant between groups.3.Two groups of patients received operations without any death.There was no significant difference in the intensive care time,plasma,red blood cell suspension and respiratory failure?defined as ventilator therapy for>72 hours,the need for reco nfiguration,the need for tracheotomy,or after surgery OI<200?.The mechanical ven tilation time between the two groups was statistically significant.4.Pearson correlation analysis showed that SPAP was positively correlated with OI?r=-0.41,P<0.01?and arterial-alveolar oxygen fraction?r=-0.45,P<0.01?after surgery.SPAP was negatively correlated with RI?r=0.45,P<0.01?and P?A-a?O2?r=0.30,P<0.01?.5.There was no significant difference in OI between the two groups of patients before the operation?F=-0.24,P=0.82?.The OI of the two groups of patients decreased to varying degrees after the surgery,reached the lowest value at 24 hours after surgery,and then slowly increased.The changes in the two groups were consistent,and the OI of time points after operation in A group was higher than that in the B group.The preoperative factor LVEF was used as a covariate for repeated measurement of covariance analysis,removing the influence of LVEF on postoperative OI?F=0.78,P=0.38?.There was no interaction effect between the two groups of patients at 3 time points after operation?F=0.04,P=0.99?,while the grouping factor?F=15.85,P<0.01?and the time factor?F=4.47,P=0.02?was different.The changes in OI at three time points after the operation were different.Separate effect analysis showed that there were differences between the two groups of A and B at 3 time points after operation and between groups?P<0.01?.6.There was no significant difference in RI between the two groups of patients before the operation?F=0.37,P=0.72?.The RI of the two groups of patients increased to varying degrees after surgery,reached the highest value at 24 hours after surgery,and then slowly decreased.The changes in the two groups were consistent,and the RI of time points after operation in A group was lower than that in the B group.The preoperative factor LVEF was used as a covariate for repeated measurement of covariance analysis,removing the influence of LVEF on postoperative RI?F=1.31,P=0.26?.There was no interaction effect between the two groups of patients at 3 time points after operation?F=1.84,P=0.17?,while the grouping factor?F=10.05,P<0.01?and the time factor?F=6.61,P<0.01?was different.The changes in RI at three time points after the operation were different.Separate effect analysis showed that there were differences between the two groups of A and B at 3time points after operation and between groups?P<0.01?.7.There was no significant difference in P?A-a?O2 between the two groups of patients before the operation?F=-0.03,P=0.98?.The P?A-a?O2 of the two groups of patients increased to varying degrees after surgery,reached the highest value at 24 hours after surgery,and then slowly decreased.The changes in the two groups were consistent,and the P?A-a?O2 of time points after operation in A group was lower than that in the B group.The preoperative factor LVEF was used as a covariate for repeated measurement of covariance analysis,removing the influence of LVEF on postoperative P?A-a?O2?F=2.06,P=0.16?.There was no interaction effect between P?A-a?O2 grouping factor and time factor?F=0.83,P=0.90?.There was no difference between time factor effect?F=1.11,P=0.34?,but there was a difference between grouping factor effect?F=5.68,P=0.02?.Separate effect analysis showed that there were differences between the two groups of A and B at 3 time points after surgery?P<0.01?.There was no difference between the groups at T3 time point?F=-1.15,P=0.15?.8.There was no significant difference in arterial-alveolar oxygen fraction between the two groups of patients before the operation?F=-0.16,P=0.87?.The arterial-alveolar oxygen fraction of the two groups of patients decreased to varying degrees after the surgery,reached the lowest value at 24 hours after surgery,and then slowly increased.The changes in the two groups were consistent,and the arterial-alveolar oxygen fraction of time points after operation in A group was higher than in the B group.The preoperative factor LVEF was used as a covariate for repeated measurement of covariance analysis,removing the influence of LVEF on postoperative arterial-alveolar oxygen fraction?F=1.11,P=0.30?.There was no interaction effect between the two groups of patients at 3 time points after operation?F=0.12,P=0.86?,while the grouping factor?F=13.33,P<0.01?and the time factor?F=5.07,P=0.01?was different.The changes in arterial-alveolar oxygen fraction at three time points after the operation were different.Separate effect analysis showed that there were differences between the two groups of A and B at 3 time points after operation and between groups?P<0.01?.9.There was no significant difference in IL-6 between the two groups of patients before the operation?F=1.30,P=0.20?.The IL-6 of the two groups of patients increased to varying degrees after surgery,reached the highest value at 24 hours after surgery,and then slowly decreased.The changes in the two groups were consistent,and the IL-6 of time points after operation in A group was lower than that in the B group.The preoperative factor LVEF was used as a covariate for repeated measurement of covariance analysis,removing the influence of LVEF on postoperative IL-6?F=1.79,P=0.19?.There was no interaction effect between the two groups of patients at 3 time points after operation?F=2.79,P=0.08?,while the grouping factor?F=15.83,P<0.01?and the time factor?F=3.64,P=0.04?was different.The changes in IL-6 at three time points after the operation were different.Separate effect analysis showed that there were differences between the two groups of A and B at 3 time points after operation and between groups?P<0.05?.Conclusion:1.Patients with VHD have secondary pulmonary artery pressure increase after cardiopulmonary bypass.2.Pulmonary artery pressure after surgery in patients with VHD is closely related to the early state of pulmonary oxygenation function,and can be used as a reference index for evaluating respiratory function in high-risk patients.3.Patients with VHD secondary increase in pulmonary artery pressure after surgery may be caused by an acute systemic inflammatory response after CPB. |
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