成人瓣膜手术体外循环中应用不同利尿剂对电解质的影响  

The Effects of different diuretics on the electrolytes in cardiac valve replacement surgery with cardiopulmonary bypass

作　　者：贾在申[1] 侯晓彤[1] 刘晓明[1] 刘晓军[1] 李砚平[1] 孙志全[1] 韩敬梅[1] 龚庆成[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所体外循环科,北京100029

出　　处：《心肺血管病杂志》2009年第3期165-167,共3页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:观察托拉塞米与呋噻米用于成人瓣膜手术体外循环(cardiopulmonary bypass,CPB)中对电解质的影响。方法:随机选取择期CPB下行瓣膜置换术患者60例,分为托拉塞米组(A组)30例,呋噻米组(B组)30例,分别在CPB前、升主动脉阻断后15min、升主动脉开放15min、CPB停机时和术后2h抽取静脉血进行血气分析,记录K+、Na+、Mg++及Ca++离子浓度。同时记录2组患者转机中尿量及自动复跳率。结果:2组患者转机前、阻断升主动脉后15minK+、Na+、Mg++及Ca++离子浓度差异无统计学意义(P>0.05);A组患者开放升主动脉后15min血K+明显高于B组,差异有显著性统计学意义(P<0.01),Mg++、Ca++差异无统计学意义(P>0.05);停机时及术后2h,2组患者血K+、Na+、Mg++及Ca++差异无统计学意义(P>0.05)。2组患者转中尿量及自动复跳率差异无统计学意义。结论:托拉塞米可以用作CPB下瓣膜置换术的利尿剂,但要注意防止复跳时的高钾。Objective： To observe the effect of torasemide and furosemide on the change of electrolytes in cardiac valve replacement surgery. Method：Sixty patients undergoing elective cardiac valve replacement surgery with cardiopulmonary bypass （CPB）were randomly assigned into two groups, torasemide group （group A）30 cases and furosemide group（group B）30 cases. Blood samples were taken to detect blood concentration of K^＋ , Na^＋ , Mg^＋＋ , Ca^＋＋ at five time points： after induction of anaesthesia, 15 min after aortic cross-clamping, 15 min after declamping, after ending CPB, and 2 hours postoperatively; Spontaneous resuscitation rate and volume of urine during CPB were recorded. Result：Blood concentration K^＋ of group A was significantly higher than group B （P 〈 0.01 ）at 15 rain after declamping ; There were no significant differences of blood concentration Na^＋ ,Mg^＋＋ ,Ca^＋＋ with respect to induction of anaesthesia, 15 min after aortic cross-clamping, 15 min after declamping, after ending CPB, and 2 hours postoperatively between two groups （P 〉 0.05 ）. Conclusion： Torasemide can be used as diuretic in cardiac valve replacement surgery, but attention must be paid to avoid the high blood concentration of K^＋ after declamping.

关 键 词：体外循环 利尿剂 托拉塞米 瓣膜置换术 

分 类 号：R542.5[医药卫生—心血管疾病]