Effect of intra-abdominal pressure in patients of advanced valvular heart disease using probiotics and lactulose after operation

doi:10.3877/cma.j.issn.1674-0793.2014.06.010

Abstract

Abstract:

Objective

To evaluate the effect of intra-abdominal pressure and the change of gastrointestinal function in patients of advanced valvular heart disease using probiotics and lactulose after operation.

Methods

From August 2013 to August 2014, fifty-six patients were selected and divided into two groups randomly: 28 cases in the treatment group, using probiotics and lactulose the first day after operation until the seventh day. The other 28 cases were the control group, undergoing the same procedure except for probiotics and lactulose. IAP was measured preoperatively, the first, second, third, fourth, and fifth day after operation in the two groups through measuring the bladder pressure. Postoperative defecation time for the first time (d), ICU stay time (h), postoperative length of hospital stay (d), incidence of IAH/ACS gastrointestinal dysfunction and mortality in the two groups were also recorded.

Results

There was no statistically significant difference between the two groups in IAP preoperatively [(3.96±1.63) mmHg vs (3.63±1.58) mmHg, t=0.44, P=0.63] and one day after operation [(11.87±2.22) mmHg vs (11.58±2.76) mmHg, t=1.62, P=0.11]. Postoperative IAP in the two groups increased at first and then decreased, reaching up to the peak at the third day in treatment group and the fourth day in the control group. At the beginning of the second day after operation, the difference was statistically significant (2-5 day after operation, t=2.24, 2.47, 4.23, 4.92, P=0.02, 0.04, 0.00, 0.00). And differences were statistically significant between groups on postoperative defecation for the first time(t=2.36, P=0.03), ICU stay time (t=3.87, P=0.00) , postoperative length of hospital stay (t=2.76, P=0.01), incidence of IAH (14.28% vs 39.28%, χ²=4.46, P=0.04) and gastrointestinal dysfunction (7.14% vs 28.57%, χ²=4.38, P=0.04).

Conclusion

Use of probiotics and lactulose in advanced valvular disease after operation can effectively reduce IAP, improve gastrointestinal function, and reduce the length of ICU and postoperative hospital stay.

Key words: Intra-abdominal hypertension, abdominal compartment syndrome (IAH/ACS), Cardiac surgery, Probiotics, Lactulose

Cuiping Wang, Song Yi, Song Yang, Bao Zhang, Wenbo Zhang, Huaming Li, Baiyun Tang. Effect of intra-abdominal pressure in patients of advanced valvular heart disease using probiotics and lactulose after operation[J]. Chinese Archives of General Surgery(Electronic Edition), 2014, 08(06): 460-464.

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References 13

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项目		治疗组	对照组	t/χ²值	P值
例数		28	28	?	?
年龄（岁，±s）		53.27±9.64	52.93 ±10.21	0.69	0.47
体质量（kg，±s）		56.43±12.21	57.44±9.38	0.94	0.37
性别（例）		?	?	?	?
?	男	12	15	0.64	0.42
?	女	16	13	?	?
心功能分级（例）		?	?	?	?
?	Ⅲ	26	27	0.00	1.00
?	Ⅳ	2	1	?	?
LVEF（%，±s）		44.53±8.52	46.34±7.68	0.96	0.37
手术种类（例）		?	?	?	?
?	MVR	5	3	1.15	0.84
?	MVR+TVP	17	20	?	?
?	AVR+MVR	5	4	?	?
?	TVR	1	1	?	?
体外循环时间（min，±s）		164.27±32.54	161.27±36.72	0.87	0.39
主动脉阻断时间（min，±s）		107.24±21.64	102.67±26.43	0.41	0.68

项目		治疗组	对照组	t/χ²值	P值
例数		28	28	?	?
年龄（岁，±s）		53.27±9.64	52.93 ±10.21	0.69	0.47
体质量（kg，±s）		56.43±12.21	57.44±9.38	0.94	0.37
性别（例）		?	?	?	?
?	男	12	15	0.64	0.42
?	女	16	13	?	?
心功能分级（例）		?	?	?	?
?	Ⅲ	26	27	0.00	1.00
?	Ⅳ	2	1	?	?
LVEF（%，±s）		44.53±8.52	46.34±7.68	0.96	0.37
手术种类（例）		?	?	?	?
?	MVR	5	3	1.15	0.84
?	MVR+TVP	17	20	?	?
?	AVR+MVR	5	4	?	?
?	TVR	1	1	?	?
体外循环时间（min，±s）		164.27±32.54	161.27±36.72	0.87	0.39
主动脉阻断时间（min，±s）		107.24±21.64	102.67±26.43	0.41	0.68

组别	例数	术前	术后第1天	术后第2天	术后第3天	术后第4天	术后第5天
治疗组	28	3.96±1.63	11.87±2.22	12.38±1.95	12.41±2.47	11.64±2.04	10.58±1.27
对照组	28	3.63±1.58	11.58±2.76	15.07±2.46	15.94±4.02	16.47±6.02	15.86±5.29
t值	?	0.44	1.62	2.24	2.47	4.23	4.92
P值	?	0.63	0.11	0.04	0.02	0.00	0.00

组别	例数	术前	术后第1天	术后第2天	术后第3天	术后第4天	术后第5天
治疗组	28	3.96±1.63	11.87±2.22	12.38±1.95	12.41±2.47	11.64±2.04	10.58±1.27
对照组	28	3.63±1.58	11.58±2.76	15.07±2.46	15.94±4.02	16.47±6.02	15.86±5.29
t值	?	0.44	1.62	2.24	2.47	4.23	4.92
P值	?	0.63	0.11	0.04	0.02	0.00	0.00

组别	例数	术后首次排便时间（d，±s）	ICU停留时间（h，±s）	术后住院时间（d，±s）	IAH[例（%）]	ACS[例（%）]	胃肠功能障碍[例（%）]	死亡[例（%）]
治疗组	28	2.53±4.84	73.44±24.76	17.24±6.52	4（14.28）	0（0）	2（7.14）	0（0）
对照组	28	5.64±3.27	124.62±44.51	26.31±7.43	11（39.28）	2（7.14）	8（28.57）	1（3.57）
t/χ²值	?	2.36^a	3.87^a	2.76^a	4.46^b	—	4.38^b	—
P值	?	0.03	0.00	0.01	0.04	0.49^c	0.04	1.00^c

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