| Objective:Valvular heart disease is one of the common types of heart disease,in which the proportion of rheumatic valvular heart disease is relatively reduced,and the number of aortic stenosis and mitral regurgitation caused by degenerative diseases is gradually increasing,which makes the quantity of patients requiring MVR under cardiopulmonary bypass gradually increase.The injury to lung caused by cardiac surgery under cardiopulmonary bypass affects the postoperative recovery of patients.The treatment of lung injury has become the crucial thing after surgery.To retrospectively analyze the relevant clinical data of sivelestat sodium after operation,compare the clinical effect of sivelestat sodium on reducing lung injury,evaluate the effectiveness of sivelestat sodium in mitral valve replacement under cardiopulmonary bypass,and provide more reference for its clinical practice and wider application.Method:The clinical data of 50 patients who received mitral valve replacement under cardiopulmonary bypass(CPB)in our hospital from October 2021 to December 2022 were selected and divided into two groups by random number table method.Those who did not use sivelestat sodium were in the non-sivelestat sodium group(n=29),and those who used sivelestat sodium were in the sivelestat sodium group(n=21).The baseline data before operation and the key time points during operation were recorded,including the time of transfer,the time of aortic cross-clamping,the time of auxiliary operation and the time of operation.In addition,WBC count,NE count,LY count,PCT and CRP measured at the next day(T1),2 days(T2)and 3 days(T3)after returning to ICU were recorded respectively;Postoperative ventilator use time,postoperative oxygen partial pressure,carbon dioxide partial pressure,total length of stay in hospital,length of stay in ICU,total cost of hospitalization were observed and recorded.Statistical analysis was performed using Jamovi2.3 and SPSS 24.0.If P<0.05,the variance between the two groups was view as statistically significant.Result:1.The comparison results of the difference in baseline data between the group using sivelestat sodium and the group not using sivelestat sodium showed no statistical significance(P>0.05),the inclusion criteria for this study were met,indicating that patients in the cilastat sodium and non-cilastat groups were comparable.2.The comparison results of Sivelestat Sodium group and Sivelestat Sodium group at key time points during operation showed that:There was no significant difference in intraoperative data between the two groups(P>0.05),so there was no statistically significant discrepancy in intraoperative operation between the crowd using sivelestat sodium and the crowd not using sivelestat sodium.3.The comparison results of different treatment measures in patients treated with sivelestat sodium and those not treated with sivelestat sodium showed that there was no statistical discrepancy in mechanical ventilation time and ICU stay(P >0.05).Murray lung injury scores(0.577±0.330 and 0.728±0.423)were both greater than 0.25,and there was no significant discrepancy between the two crowd(P> 0.05).Postoperative lung injury occurred in both groups.Statistically,there was no significant discrepancy in the degree of lung injury.The total length of hospital stay(d)was 27.8±6.10 <36.4±8.15,with statistical significance(P<0.05).The total length of hospital stay in the group using sivelestat sodium was lower than that in the group not using sivelestat sodium,with statistical significance.The total hospitalization cost(12.4±3.78 yuan)was less than 18.8±9.80 yuan and had statistical significance(P<0.05).The total hospitalization cost of the group using sivelestat sodium was lower than the group that did not use cilastat sodium,and had statistical significance.The mean arterial partial pressure of oxygen(84.1±2.49)was greater than81.4±2.65 at 3 days after operation,with statistical significance(P<0.05).The mean partial pressure of carbon dioxide(38.2±1.57)was less than 40.0±2.34 at 3 days after operation,with statistical significance(P<0.05).4.The comparison results of different treatment measures in patients treated with sivelestat sodium and those not treated with sivelestat sodium showed that there was no statistical discrepancy in mechanical ventilation time and ICU stay(P >0.05).Murray lung injury scores(0.577±0.330 and 0.728±0.423)were both greater than 0.25,and there was no significant discrepancy between the two crowds(P> 0.05).Postoperative lung injury occurred in both groups,and there was no statistical significance in the degree of lung injury.The total length of hospital stay(d)was27.8±6.10 <36.4±8.15,with statistical significance(P<0.05).The total length of hospital stay in the group using sivelestat sodium was lower than that in the group not using sivelestat sodium,with statistical significance.The total hospitalization cost(12.4±3.78 yuan)was less than 18.8±9.80 yuan and had statistical significance(P<0.05).The total hospitalization cost of the group using sivelestat sodium was lower than that of the group not using sivelestat sodium,and had statistical significance.The mean arterial partial pressure of oxygen(84.1±2.49)was greater than81.4±2.65 at 3 days after operation,with statistical significance(P<0.05).The mean partial pressure of carbon dioxide(38.2±1.57)was less than 40.0±2.34 at 3 days after operation,with statistical significance(P<0.05).Conclusion:In this study,by comparing the general baseline data,intraoperative key time points,postoperative ICU stay,total hospital expenses,total hospital stay,postoperative oxygen partial pressure,postoperative carbon dioxide partial pressure and postoperative relevant laboratory indicators of patients in Sivelestat sodium group and non-Sivelestat sodium group,the following conclusions were drawn:1.Sivelestat sodium can improve partial pressure of oxygen and partial pressure of carbon dioxide after simple MVR surgery.2.Sivelestat sodium can reduce lung injury caused by CPB after MVR surgery alone.3.Sivelestat sodium can reduce the total length of hospital stay and hospitalization costs,thus reducing the cost of hospitalization and saving medical resources to a certain extent.4.Sivelestat sodium reduces systemic inflammatory response in patients after isolated MVR surgery. |
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