艾司洛尔对不停跳心内直视手术心肌的保护作用  

Protective effect of esmolol on the myocardium during open heart beating surgery

作　　者：龚倩[1] 葛建军[1] 葛圣林[1] 林敏[1] 周汝元[1] 高晴云[1] 

机构地区：[1]安徽医科大学第一附属医院心脏外科,合肥230022

出　　处：《中国心血管杂志》2012年第1期3-6,共4页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨β1受体阻滞剂艾司洛尔在不停跳心内直视手术中对心肌的保护作用。方法选择22例择期行房间隔修补手术患者,随机分为两组,每组11例,两组均在常温体外循环心脏不停跳心内直视下进行房间隔修补手术。实验组在体外循环开始前于预冲液中加入艾司洛尔1 mg/kg,转机过程中再以300μg.kg-1.min-1的速度从静脉持续输注艾司洛尔,直到手术完成。对照组给予等量的生理盐水代替艾司洛尔,其余和实验组相同。监测两组病例在各个时间点的血流动力学、血气分析、心肌损伤标志物及围手术期各项临床指标,并进行对比。结果在转机过程中,实验组心率(56±8)次/min显著低于对照组(64±9)次/min(P<0.05),实验组cTnI和CK-MB在术后6、12、24 h各个时间点均显著低于对照组(均为P<0.001),两组病例在手术开始前、转机开始前、转机过程中、停机后和手术结束后各个时间点的血气分析指标差异无统计学意义(均为P>0.05)。结论在常温体外循环心脏不停跳心内直视手术中应用艾司洛尔可以显著保护心肌并改善手术操作条件。Objective To investigate the cardiac protective effect of esmolol during open heart beating surgery. Methods Twenty-two patients with atrial septal defect （ASD） undergoing elective open heart beating surgery were randomly divided into two groups. Each group had 11 patients. Experimental group received open heart beating surgery with normothermia cardiopulmonary bypass （CPB）. Esmolol was added into the cardioplegic solution with 1 mg·kg-1, and then esmolol was continuous infusion intravenously with 300 μg·kg^-1·min^-1 during CPB until the end of surgery. Control group received saline instead of esmolol. The hemodynamics, blood gas analysis and cardiac injury markers of different time and clinical parameters of peri-operative period were recorded and compared. Results The heart rate （HR） during the course of CPB in experimental group [ （56 ± 8 ） beats per minute （bpm） ] was significantly lower than that in control group [ （64 ± 9） bpm, P 〈 0. 05 ]. Compared with control group, the serum concentrations of cardiac injury markers cTnI and CK-MB at each time point after surgery in experimental group were significantly lower than those in control group （all P 〈 0. 001 ）. Data of blood gas analysis were not statistically significant at any time point between two groups. Conclusions Application of esmolol during open heart beating surgery with normothermia CPB may protect myocardium and provide a better surgical condition.

关 键 词：心脏外科手术 艾司洛尔 体外循环 不停跳 

分 类 号：R654.2[医药卫生—外科学]