双心房输注对二尖瓣置换术患者体外循环后肺动脉压的影响  

Effects of biatrial infusion on pulmonary artery pressure after cardiopulmonary bypass in patients undergoing mitral valve replacement

作　　者：王凤芝 王少林[1] 钟文胜[1] 张平[2] 肖春莲[1] 杨小刚[3] 曲良超[4] 郭善亮[4] 

机构地区：[1]江西省人民医院麻醉科,南昌市330006 [2]江西省人民医院胸外科,南昌市330006 [3]江西省人民医院ICU,南昌市330006 [4]南昌大学医学院麻醉学系

出　　处：《中华麻醉学杂志》2010年第8期950-952,共3页Chinese Journal of Anesthesiology

基　　金：江西省卫生厅资助项目（050291）

摘　　要：目的 评价双心房输注对二尖瓣置换术患者体外循环后肺动脉压（PAP）的影响.方法 择期行二尖瓣置换术合并肺动脉高压[平均肺动脉压（MPAP）＞50 mm Hg]的患者20例,年龄22～53岁,体重34～57kg,心功能分级Ⅱ或Ⅲ级,随机分为2组（n=10）：右心房输注组（R组）和双心房输注组（B组）.麻醉诱导后右颈内静脉穿刺置入Swan-Ganz三腔漂浮导管,监测CVP、PAP、肺毛细血管楔压（PCWP）和CO.R组经中心静脉输注前列腺素E130～150 ng·kg-1·min-1和去氧肾上腺素0.2～0.6μg·kg-1·min-1.B组经中心静脉输注前列腺素E130～150 ng·kg·min-1,经左心房输注去氧肾上腺素0.2～0.6μg·kg-1·min-1.分别于给药前5 min（T0）、给药后5 min（T1）、10 min（T2）、30 min（T3）和60 min（T4）时记录MAP、HR、MPAP、PCWP、CVP和CO,计算肺血管阻力指数（PVRI）、体循环血管阻力指数（SVRI）和CI.结果 与T0时比较,R组T1-4时MAP、MPAP、PCWP和PVRI降低,CI升高（P＜0.05）,HR、CVP和SVRI差异无统计学意义（P＞0.05）,B组T1-4时MAP、CI和SVRI升高,HR、MPAP、PCWP、CVP和PVRI降低（P＜0.05）;与R组比较,B组MAP、CI和SVRI升高,HR、MPAP、PCWP、PVRI和CVP降低（P＜0.05）.结论 双心房输注可降低二尖瓣置换术患者体外循环后肺动脉压和肺血管阻力.Objective To investigate the effects of biatrial infusion on pulmonary artery pressure （PAP）after cardiopulmonary bypass （CPB） in patients undergoing mitral valve replacement.Methods Twenty NYHA Ⅱ or Ⅲ patients aged 22-53 yr weighing 34-57 kg undergoing mitral valve replacement complicated by pulmonary hypertension （mean pulmonary artery pressure （MPAP） ＞ 50 mm Hg） were randomly divided into 2 groups （ n = 10 each）： infusion via right atrium group （group R） and infusion via both atria group （group B）. After induction of anesthesia, a three cavity floating Swan-Ganz catheter was placed via right internal jugular vein to monitor CVP,PAP, pulmonary capillary wedge pressure （PCWP） and CO. The patients received infusion of prostaglandin E1 30-150 ng· kg- 1 · min - 1 and phenylephrine 0.2-0.6 μg· kg- 1 · min- 1 via central veins in group R and infusion of prostaglandin E1 30-150 ng·kg-1 ·min-1 via central veins and phenylephrine 0.2-0.6 μg·kg-1 ·min-1 via left atrium in group B. MAP, HR, MPAP, PCWP, CVP and CO were recorded 5 min before administration （T0）, and 5,10, 30 and 60 min after administration （T1-4）. Pulmonary vascular resistance index （PVRI）, systemic vascular resistance index （SVRI） and CI were also calculated. Results D：／1111111111／MDB／zhmzxzz98201008.mdbCompared with the value at T0, MAP, MPAP, PCWP and PVRI were significantly decreased, while CI was increased at T1-4 in group R, and MAP, CI and SVRI were significantly increased, while HR, MPAP, PCWP, CVP and PVRI decreased at T1-4 in group B （ P ＜ 0.05）.MAP, CI and SVRI were significantly higher, while HR, MPAP, PCWP, PVRI and CVP lower in group B than in group R （ P ＜ 0.05）. Conclusion Biatrial infusion can effectively reduce PAP and pulmonary vascular resistance after CPB in patients undergoing mitral valve replacement.

关 键 词：高血压 肺性 心肺转流术 双心房输注 

分 类 号：R654.2[医药卫生—外科学]