| Ojective: Cardioplumonary bypass(CPB)is a controllable "shock" process,accompanied with changes in hemodynamics.Timely and reliable monitoring means is conducive to the early diagnosis the hemodynamic changes of CPB,as well as the judgement of illness and guidance of treatment.Color Doppler Ultrasound is a noninvasive and repeatable clinical assistant method,used for observing various cardiovascular hemodynamics widely for it’s noninvasive and repeatable.This study was carried out to observe the changes of hemodynamics of the Peripheral artery(carotid artery,brachial artery,femoral artery)and renal artery of the renal portal during perioperative period of CPB in patients with heart valve replacement by Color Doppler Flow Imaging(CDFI)to disclose the regularity of peripheral artery hemodynamics.The molecular mechanism of hemodynamic changes of peripheral arteries was analyzed by combining the detection of angiotensin II(AngII),tumor necrosis factor alpha(TNF-a)and lactic acid during perioperative period.In addition,the hemodynamics of peripheral artery and renal artery were compared,and the correlation was analyzed as well,which laid a foundation for clinical application research of peripheral arterial hemodynamics in later stage.Methods: 60 cases with rheumatic heart disease who underwent valve replacement surgery in our hospital were selected from May 2016 to September 2017 in our hospital(CPB group),30 cases of non heart surgery patients(experimental group)and 30 cases of healthy patients(control group)in the same period were taken as control in this period.The systolic peak flow velocity(PSV),end diastolic velocity(EDV),pulsatility index(PI)and resistance index(RI)of peripheral artery and renal artery of each group were measured by CDFI.Patients in the control group were measured once.Patients in the experimental control group were measured once,And that in the experimental control group were measured once after operation in intensive care unit(ICU)during anaesthesia without getting out of the ventilator.In the CPB group,patients were respectively measured before operation and 2h,6h,12 h,24h after operation.Meanwhile,the concentration of AngII,TNFalpha,lactic acid and left ventricular ejection fraction(EF)were measured at the corresponding time point in the CPB group.Comparison were taken among groups of preoperative of the CPB group,experimental group,and control group.The hemodynamics of peripheral artery and renal artery,blood AngII and TNF-a were compared in the CPB group,and the correlation analysis was carried out.In addition,according to the measurement results of blood lactate at the 6h after operation,taking lactate 5mmol/L as the boundary,more than 5mmol/L as high lactate group(n=22),less than 5mmol/L as low lactate group(n=38).Comparing the Doppler parameters of peripheral artery blood flow at the 6h after operation as the comparison index,the general data of the two groups and the Doppler parameters of the peripheral artery hemodynamics were compared.Results:(1)The comparison was made among the three groups of the CPB group before the operation,experimental group,and control group:(1)General information in three groups :there was no statistical difference about age,sex,and body mass index(BMI)in the three groups(P>0.05).(2)Doppler parameters of peripheral arterial blood flow and renal artery blood flow in three groups: there was no statistical difference about doppler parameters of peripheral arterial blood flow and renal artery blood flow in the three groups.(2)Comparison intra CPB group:(1)The peripheral artery and renal artery blood flow PSV,PI,RI,at postoperative 2h,6h,12 h were higher than preoperative,and the postoperative 2h was obvious.namely: A)Carotid artery blood flow PSV at postoperative 2h,6h,12 h were 105.19±13.5(cm/s),99.23±9.3(cm/s),96.56±10.81(cm/s),compared with preoperative 90.6±10.33(cm/s),there were statistically significant difference(P<0.05);Carotid artery blood flow PI at postoperative 2h,6h,12 h were 1.91±0.3,1.79±0.19,1.7±0.1,compared with preoperative 1.44 ± 0.35,there were statistically significant difference(P<0.05);Carotid artery blood flow RI at postoperative 2h,6h,12 h were 0.78±0.06,0.76±0.02,0.75±0.03,compared with preoperative 0.66±0.09,there were statistically significant difference(P<0.05).B)Brachial artery blood flow PSV at postoperative 2h,6h,12 h were 81.05±11.07(cm/s),76.62±8.55(cm/s),69.51±9.64(cm/s),compared with preoperative 57.3±11.17(cm/s),there were statistically significant difference(P<0.05);Brachial artery blood flow PI at postoperative 2h,6h,12 h were 2.52±0.29,2.31±0.1,2.29±0.06,compared with preoperative 2.2 ± 0.12,there were statistically significant difference(P<0.05);Brachial artery blood flow RI at postoperative 2h,6h,12 h were 1.22±0.24,1.17±0.21,1.12±0.22,compared with preoperative 0.91±0.25,there were statistically significant difference(P<0.05).C)Femoral artery blood flow PSV at postoperative 2h,6h,12 h were 130.48 ± 15.64(cm/s),128.31 ± 17.9(cm/s),129.63±16.46(cm/s),compared with preoperative 117.4±19.99(cm/s),there were statistically significant difference(P<0.05);Femoral artery blood flow PI at postoperative 2h,6h,12 h were 11.95±0.24,11.64±0.23,11.34±0.18,compared with preoperative 10.77 ± 0.82,there were statistically significant difference(P<0.05);Femoral artery blood flow RI at postoperative 2h,6h,12 h were 1.08 ± 0.25,1.04 ± 0.14,0.93 ± 0.11,compared with preoperative 1±0.16,there were statistically significant difference(P<0.05).D)Renal artery blood flow PSV at postoperative 2h,6h,12 h were 98.08±10(cm/s),93.12±11.83(cm/s),91.92±11.31(cm/s),compared with preoperative 89.17±10.79(cm/s),there were statistically significant difference(P<0.05);Renal artery blood flow PI at postoperative 2h,6h,12 h were 1.82±0.37,1.67±0.35,1.53±0.25,compared with preoperative 1.32±0.23,there were statistically significant difference(P<0.05);Renal artery blood flow RI at postoperative 2h,6h,12 h were 0.77 ± 0.1,0.76 ± 0.08,0.72 ± 0.08,compared with preoperative 0.65 ± 0.03,there were statistically significant difference(P<0.05).Peripheral artery and renal artery blood flow PSV,PI,RI at postoperative 24 h,compared with preoperative,there were no statistical significance in the difference(P>0.05).(2)The blood flow Doppler parameters of peripheral and renal arteries were significantly decreased at 2h,6h 12 h after EDV compared with those before operation,especially at 2h after operation.namely : A)Carotid artery blood flow EDV at postoperative 2h,6h,12 h were 20.81±4.18(cm/s),22.13±2.83(cm/s),23.76±3.22(cm/s),compared with preoperative 26.36±6.03(cm/s),there were statistically significant difference(P<0.05).B)Brachial artery blood flow EDV at postoperative 2h,6h,12 h were 12.41±1.94(cm/s),13.01±2.03(cm/s),14.8±1.89(cm/s),compared with preoperative 16.37±2.24(cm/s),there were statistically significant difference(P<0.05).C)Femoral artery blood flow EDV at postoperative 2h,6h,12 h were8.8±2.38(cm/s),9.35±1.76(cm/s),9.35±1.76(cm/s),compared with preoperative 10.95±2.43(cm/s),there were statistically significant difference(P<0.05).D)Renal artery blood flow EDV at postoperative 2h,6h,12 h were19.12±2.05(cm/s),21.39±1.89(cm/s),22.87±2.47(cm/s),compared with preoperative 25.38±3.32(cm/s),there were statistically significant difference(P<0.05).Peripheral artery and renal artery blood flow EDV at postoperative 24 h,compared with preoperative,there were no statistical significance in the difference(P>0.05).(3)Comparison between high lactic acid group and low lactic acid group:(1)Comparison of General information:there was no statistical difference about age,sex,and heart function in two groups(P>0.05).in high lactate group,CPB time was 117.54±14.23(min),respirator assisted time was 15.62±2.64(h),and ICU time was 2.34±0.97(d),longer than that in low lactic acid group 106.45±11.24(min),13.93±3.07(h),1.49±1.11(d),there were statistically significant difference(P<0.05).(2)Comparison of the peripheral arterial hemodynamics in two groups:the peripheral artery PI,RI in the high lactate group was lower than that in the low lactate group,which was that carotid artery PI 1.63±0.25 RI 0.75±0.03,femoral artery PI 10.96±0.31 RI 1.23±0.14,brachial artery PI 1.07±0.16 RI 1.07±0.16 in the high lactate group,lower than 1.85±0.16 0.76±0.02,11.23±0.42 1.31±0.14,2.35±0.13 1.22±0.22 in low lactate group,there were statistically significant difference(P<0.05).(4)The linear regression analysis between doppler parameters of peripheral artery and renal artery blood flow and AngII,TNF-a in CPB group:(1)Taking AngII as the strain y,carotid artery PSV,EDV,PI,RI as independent variable x,for linear regression analysis,Linear regression equation:y=0.715x-38.602,y=-0.416x+57.275,y=15.201x+19.600,y=88.924x-21.125;taking TNF-a as the strain y,carotid artery PSV,EDV,PI,RI as independent variable x,for linear regression analysis,Linear regression equation:y=0.237x+23.709,y=-0.942x+133.354,y=41.299x+34.90 1,y=259.890x-90.097.(2)Taking Ang II as the strain y,brachial artery PSV,EDV,PI,RI as independent variable x,for linear regression analysis,Linear regression equation:y=0.677x+58.926,y=-4.096x+165.803,y=43.391x+4.622,y=56.153x+45.485;taking TNF-a as the strain y,brachial artery PSV,EDV,PI,RI as independent variable x,for linear regression analysis,Linear regression equation:y=0.234x-29.651,y=-1.236x+64.331,y=16.392x+9.398,y=20.034x+24.268.(3)taking AngII as the strain y,femoral artery PSV,EDV,PI,RI as independent variable x,for linear regression analysis,Linear regression equation:y=0.508x+547.491,y=-3.596x+145.416,y=5.067x+56.856,y=50.596x-59.187;taking TNF-a as the strain y,femoral artery PSV,EDV,PI,RI as independent variable x,for linear regression analysis,Linear regression equation:y=0.166x+27.023,y=-1.186+59.070,y=1.848x+27.875,y=20.319x+26.711.(4)taking AngII as the strain y,renal artery PSV,EDV,PI,RI as independent variable x,for linear regression analysis,Linear regression equation:y=0.911x+25.513,y=-2.869+169.944,y=34.833x+50.262,y=136.118x+ 8.584;taking TNF-a as the strain y,renal artery PSV,EDV,PI,RI as independent variable x,for linear regression analysis,Linear regression equation:y=0.340x+14.925,y=-1.067x+69.518,y=12.690x+25.494,y=47.929x+11.593.(5)linear correlation analysis of peripheral artery and renal artery blood flow doppler parameters:(1)carotid artery blood flow EDV,PI,RI are positively related to renal artery blood flow(r=0.502,0.463,0.785,0.766 P<0.05).(2)brachial artery blood flow EDV,PI,RI are positively related to renal artery blood flow(r=0.519,0.616,0.795,0.716 P<0.05).(3)femoral artery blood flow EDV,PI,RI are positively related to renal artery blood flow(r=0.465,0.516,0.787,0.785 P<0.05).Conclusion:(1)The hemodynamic changes of peripheral artery and renal artery were induced by CPB,but there was no significant change in the hemodynamics of the peripheral arteries and renal arteries after general anesthesia.(2)The hemodynamics of peripheral artery and renal artery regularly changes in CPB postoperative period,early postoperative vascular resistance and the peak systolic velocity increased,the hemodynamics tended to be stable at one day after the operation.(3)The hemodynamic changes of peripheral and renal arteries in perioperative period of CPB are closely related to neurohumoral regulation,inflammatory reaction,lactic acid and other factors.(4)Peripheral artery ultrasound could be used as an alternative method to reflect the perfusion of important organs such as renal artery as the changes of peripheral arterial blood flow were positively correlated with the changes of renal artery blood flow during CPB perioperative period.(5)the occurrence of hyperlactic acidemia in perioperative period of CPB is closely related to the time of CPB for the former can reduce peripheral vascular resistance.Moreover,the changes of peripheral artery hemodynamics reflect the whole body hemodynamics and microcirculation perfusion to some extent.(6)In the later stage,it is possible to detect the changes of peripheral artery hemodynamics in order to detect the injury of important organs and the occurrence of serious complications such as LCOS,vascular paralysis syndrome,and lay the foundation of the diagnosis of the disease during the treatment and other related research,on the account of the change of the hemodynamics of peripheral artery during the perioperative period of CPB. |
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