冠脉搭桥术后早期心肌缺血的防治与监测  

Control and Monitoring of Myocardial Ischemia on the Early of Coronary Artery Bypass Grafting

作　　者：赵谊[1] 穆心苇[1] 章淬[1] 施乾坤[1] 

机构地区：[1]江苏省南京医科大学附属南京市第一医院ICU,210006

出　　处：《中华全科医学》2010年第12期1531-1532,共2页Chinese Journal of General Practice

摘　　要：目的评价尼卡地平对冠状动脉搭桥术(CABG)后早期心肌缺血的预防作用并观察其血流动力学效应。方法 40例择期接受CABG患者,术后随机分3组,予以尼卡地平(NIC组)或硝酸甘油(NTG组)预防冠脉痉挛及治疗高血压各15例,不给药(C组)10例。床边心电监护及动态ST段分析监测心肌缺血。结果心肌缺血发作情况:NIC组术后24h内有2例ST段变化(占13%),各发生1次;NTG组有6例患者ST段变化(占44%),每个患者发生平均(6±2)次;C组有7例ST段变化(占70%),每个患者发生平均(9±4)次。NIC组术后ST段改变明显少于其余两组,达到目标血压所需时间短。给药前后心率(HR)和中心静脉压(CVP)无明显改变,给药后30min外周血管阻力(SVR)下降显著,心排指数(CI)显著升高。结论尼卡地平不仅能有效地控制冠状动脉搭桥围术期高血压,还具有抗心肌缺血的优点。Objective To evaluation of nicardipine on the early of coronary artery bypass grafting（CABG） after the preventive effect of myocardial ischemia and hemodynamie effects were observed. Methods 40 cases of elective CABG patients were randomly divided into three groups after operation, receiving nicardipine （NIC group） or receiving nitroglycerin to prevent coronary artery spasman and treat hypertension,each group 15;10 were not given medicine （C group）. Heart electricity guard and dynamic section ST analysis were employed to monitor cardiac muscle to be ischemic by the bed. Results Myocardial ischemia attacking situation： NIC group within 24 h,two cases of ST segment changes（ 13% ） ,occurred in a sub;NTG group,6 patients with ST segment changes（44% ） , each patient took place an average of 6 ± 2;C group ,7 eases of ST segment changes（ 70% ） of each patient an average of 9 ± 4 times occurred. NIC group postoperative section ST change, less than other two groups obviously, reaching goal blood pressure necessary time was shortened. HR and CVP before and after administration.was no significant change, in 30 min after administration,peripheral vascular resistance（SVR） decreased significantly,cardiac index（CI） increased significantly. Conclusion Nicardipine was not only an effective control of perioperative hypertension in CABG,but also had the advantage of anti- myocardial ischemia.

关 键 词：冠状动脉搭桥术 心肌缺血 尼卡地平 监测 

分 类 号：R541.4[医药卫生—心血管疾病] R654.33[医药卫生—内科学]