异丙酚对心内直视手术心脏复跳后血流动力学的影响  

Effect of propofol on hemodynamics and ST segment after heart rebeating in patients with heart operation

作　　者：张建欣[1] 徐美英[1] 

机构地区：[1]中国人民解放军第二军医大学附属长海医院麻醉科,上海200433

出　　处：《中国临床药学杂志》2000年第2期69-72,共4页Chinese Journal of Clinical Pharmacy

摘　　要：目的 :观察异丙酚对心内直视手术患者心脏复跳后的血流动力学影响。方法 :2 4例 ASA (美国麻醉师学会 )体格状况分级 ～ 级、心功能 ～ 级的心内直视手术患者。静脉快速诱导、气管内插管后随机分成两组 :A组诱导后异丙酚 2 m g·kg- 1· h- 1及芬太尼 5 μg· kg- 1· h- 1持续微泵推注 ,B组芬太尼 10 μg· kg- 1· h- 1微泵持续推注。所有病人入室后连接惠普(HP)监护仪监测 ECG、BP、Sp O2 、吸入麻醉气体浓度。 Vigilance型 CCO/SvO2 监护仪持续监测 CCO和 SvO2 。分别于诱导前、诱导后、锯胸骨后、主动脉插管后及停机后、关胸前、关胸后输入所需参数计算 CI、SVRI及其他血流动力学指标。结果 :A组病人主动脉开放后心脏自动复跳率高 ,复跳时心肌缺血不明显。B组自动复跳率低 (但无统计学差异 ) ,有 2例应用电除颤或药物除颤 ,复跳后心肌缺血较明显 (P<0 .0 5 )。A组心律失常发生率明显降低 ,B组室早、室速、室上速等心律失常的发生率较高。A组心脏复跳后 CI较 B组恢复快 ,但外周阻力降低较明显 (P<0 .0 1)。结论 :异丙酚可增加心内直视手术患者主动脉开放后心脏的自动复跳率 ,减轻复跳后的心肌缺血、减少心律失常发生率 ,并可改善复灌后的心功能 。AIM: To evaluate the effect of propofol on hemodynamics and ischemia reperfusion of myocardium and arrhythemia after heart rebeating. METHODS: Twenty four patients, American Society of Anesthesiologists (ASA) grade Ⅲ-Ⅳ were randomly divided into 2 groups, infusion with propofol 2 mg·kg -1 ·h -1 combined with fentanyl 5 μg·kg -1 ·h -1 in group A and fentanyl 10 μg·kg -1 ·h -1 in group B. All patients received pethidine 1 mg/kg and phenergan 0 5 mg/kg intramuscularly 0 5 h before anesthesia. After an intraarterial line being placed in the left radial artery and a flow directed balloon tipped Baxter CCO/S O 2 thermodilution catheter being passed from the right jugular vein to the pulmonary artery and positioned to obtain a reliable pulmonary wedge pressure tracing during balloon inflation, baseline value was obtained. All patients were induced with midazolam 0 1 mg/kg, fentanyl 10 μg/kg, pancuronium 0 1 mg/kg or vecuronium 0 1 mg/kg and then intubated. Ventilation was given by Ohmeda Excel 80 ventilator and the concentration of isoflurane was measured by HP gas monitor. ECG, ST segment and CCO/S O 2 were supervised by HP monitor and Baxter CCO/S O 2 monitor. RESULTS: No significant differences were found between the 2 groups in age, sex, height and body weight, body surface area (BSA). After cross clamp removal from aorta (reperfusion period), the ratio of heart spontaneous rebeating was high, while the ST segment variation was decreased obviously at the interval of the heart rebeating in group A. The occurrence of reperfusion arrhythmia (RA) was significant fewer in group A ( P <0 05), but SVRI was lower ( P <0 01) and more colloid or crystal liquor should be infused. CONCLUSION: The infusion of propofol in sedation dose can reduce the myocardial ischemia reperfusion injury and inprove the heart function after myocardial reperfusion.

关 键 词：心内直视术 心脏复跳 血流动力学 异丙酚 

分 类 号：R971[医药卫生—药品]