甲泼尼龙对体外循环后患者液体平衡及临床结果的影响  

Effects of methylprednisolone on fluid balance and clinical outcome after cardiopulmonary bypass

作　　者：郭克芳[1] 姜桢[1] 罗红[1] 金翔华[1] 

机构地区：[1]复旦大学附属中山医院麻醉科,上海市200032

出　　处：《中华麻醉学杂志》2007年第3期204-208,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价甲泼尼龙对低温体外循环（CPB）后患者液体正平衡、术后心血管功能稳定性和临床结果的影响。方法择期瓣膜置换或修复术成年患者32例,ASAⅡ级或Ⅲ级,随机分为2组,每组16例,对照组（NS组）麻醉诱导后静脉注射生理盐水10ml;试验组（MP组）麻醉诱导后静脉注射甲泼尼龙10mg/kg10 ml。监测术中及术后血液动力学和呼吸功能,记录术后气管导管留置时间、ICU停留时间、住院天数、术后血管活性药的用量及术后并发症的发生情况。于手术结束时、术后6 h和20 h计算液体净平衡。结果2组胶体液净平衡比较差异无统计学意义（P＞0．05）;与NS组比较, MP组手术结束时和术后20 h晶体液净平衡降低,CPB后心输出量、心脏指数升高,而CPB后各时点体循环阻力降低,CPB后即刻氧合指数升高（P＜0．05）;2组气管导管留置时间、ICU停留时间、住院天数和术后血管活性药的用量差异无统计学意义（P＞0．05）。结论麻醉诱导后静脉注射10 mg/kg甲泼尼龙可降低低温CPB后患者液体正平衡,提高术后心血管功能的稳定性,在一定程度上改善肺的氧合功能。Objective To investigate whether 10 mg/kg methylprednisolone （MP）; could effectively reduce positive fluid balance following hypothermic cardiopulmonary bypass （CPB）, enhance postoperative cardiovascular stability and improve clinical outcome. Methods Thirty-two adult patients undergoing elective single or double valve repair or replacement with moderate hypothermic CPB were randomly divided into 2 groups （ n = 16 each） ： control group and MP group. MP 10 mg/kg was given intravenously after induction of anesthesia. The patients were premedicated with intramuscular morphine 0.1 mg/kg and scopolamine 0.3 mg. Anesthesia was induced with midazolam 50-100 μg/kg, fentanyl 5-8 μg/kg and rocuronium 0.8-1.0 mg/kg and maintained with fentanyl, propofol, isoflurane and pipecuronium. Left radial artery was caunulated for BP monitoring and CCO thermal dilution catheter （Edward Lifesciences） was placed via right internal juglar vein for hemodynamic monitoring. Tracheal extubation time, length of ICU and hospital stay and postoperative complications were recorded. The net balance of crystalloid, colloid and total fluid were calculated （net balance = input - output）. Results The two groups were comparable with respect to M/F sex ratio, age, body weight and height, aorta cross-clamping time, CPB time and intraoperative blood-loss. The cardiac output （CO） and cardiac index （CI） were significantly higher whereas SVR was significantly lower immediately after termination of CPB in group MP than in control group. P（A-a） DO2 was significantly increased immediately after termination of CPB as compared with the baseline before anesthesia in both groups but there was no significant difference between the two groups. PaO2/FiO2 was significantly higher after aortic declamping in group MP than in control group. A significant positive fluid balance caused by excess crystalloid input was found at the end of operation in beth groups. The camulated net crystalloid balance was 47 ml/kg in control group and 32 m

关 键 词：甲泼尼龙 心肺转流术 补液疗法 

分 类 号：R686[医药卫生—骨科学]