血管加压素对心肺转流术后血管麻痹综合征患者血流动力学的影响  

Effect of arginine vasopressin on systemic hemodynamics in vasodilatoryvasoplegic syndrome patients following cardiopulmonary bypass

作　　者：袁志国[1] 谢红[1] 

机构地区：[1]江苏省泰州市人民医院南院麻醉科,江苏泰州225300

出　　处：《实用临床医药杂志》2011年第11期19-21,28,共4页Journal of Clinical Medicine in Practice

摘　　要：目的评价血管加压素对心肺转流术(CPB)后血管麻痹综合征患者血流动力学的影响。方法选取CPB下心脏手术后发生血管麻痹综合征患者14例,分为去甲肾上腺素(NE)组(NE组)和血管加压素(AVP)组(AVP组)。NE组患者输注NE维持平均动脉血压>65 mmHg,当NE输注速率>0.4μg/(kg.min)则加用AVP 0.01～0.04 U/min;AVP组患者输注AVP0.01～0.04 U/min,必要时使用NE维持患者平均动脉血压>65 mmHg。于血管麻痹综合征诊断时(T1,基础值)、注药后24 h(T2)、48 h(T3)、72 h(T4)分别记录两组患者心率(HR)、平均动脉压(MAP)、平均肺动脉压(MPAP)、心排血量(CO)、肺毛细血管楔压(PCWP)、中心静脉压(CVP)及尿量,计算体循环血管阻力(SVR)及肺循环血管阻力(PVR)。并记录儿茶酚胺药物使用量及不良反应。结果两组患者年龄、体重、性别构成比,术前EF、术前治疗用药情况、CPB时间、主动脉阻断时间比较差异无统计学意义(P>0.05)。两组患者血压维持稳定。与NE组比较,AVP组SVR T2时增加;HR T2～3时显著降低(P<0.05);NE需要量T2～4明显降低(P<0.05);尿量明显增加(P<0.05)。结论 AVP可以改善CPB术后血管麻痹综合征患者的血流动力学。Objective To investigate the effects of arginine vasopressin（AVP） on hemodynamicsin vasodilatory vasoplegic syndrome patients following cardiopulmonary bypass（CPB）.Methods Fourteen vasodilatory shock patients undergoing heart surgery following CPB were randomized into 2 groups（n=7 each）： norepinephrine group（NE group） and arginine vasopressin group（AVP group）.In NE group,a NE infusion was started to maintain MAP higher than 65 mmHg,and AVP was added when NE infusion rate was higher than 0.4 μg/（kg·min）.In AVP group,an AVP infusion was started at an infusion rate between 0.01～0.04 U/min.If necessary,a NE infusion was added to maintain MAP higher than 65 mmHg.MAP（mean arterial pressure）,HR（heart rate）,mean pulmonary arterial pressure（MPAP）,central venous pressure（CVP）,pulmonary capillary wedge pressure（PCWP）,cardiac output（CO）,urine output and catecholamine requirements were recorded when vasodilatory vasoplegic syndrome was diagnosed（T1）,24 h（T2）,48 h（T3）,and 72 h（T4）after the treatment respectively.Systemic vascular resistance（SVR） and pulmonary vascular resistance（PVR） were calculated.Meanwhile,side effects were recorded.Results There were no significant differences between the two groups with respect to age,sex,body weight,CPB time and aortic cross-clamping time,MAP,PVR（P0.05）.HR was lower and catecholamine requirements were less pronounced at T2～4 in group AVP when compared with those of group NE（P0.05）.SVR was higher in AVP group at T2,urine output was significantly higher at T2～3 in group AVP than in group NE（P0.05）.No adverse side effects were observed.Conclusion AVP infusion can improve hemodynamics in vasodilatory vasoplegic syndrome patients undergoing cardiac surgery following CPB.

关 键 词：血管加压素 心肺转流术 血管麻痹综合征 血流动力学 不良反应 

分 类 号：R654.1[医药卫生—外科学]