非体外循环冠状动脉旁路移植术患者围术期血浆血管加压素和血管紧张素Ⅱ的变化及其对转归的影响  

Relationship between perioperative changes in plasma arginine vasopressin and angiotensin II and outcome in patients undergoing off-pump coronary artery bypass grafting

作　　者：杨彦伟[1] 李书闻[1] 程卫平[1] 王成彬[1] 李秀兰[1] 高宇翔[1] 

机构地区：[1]首都医科大学附属北京安贞医院麻醉科,100029

出　　处：《中华麻醉学杂志》2012年第6期653-656,共4页Chinese Journal of Anesthesiology

摘　　要：目的探讨非体外循环（CPB）冠状动脉旁路移植术患者围术期血浆血管加压素（VP）和血管紧张素Ⅱ（AngⅡ）的变化及其对转归的影响。方法择期行非CPB冠状动脉旁路移植术患者50例，性别不限，年龄45～79岁，ASA分级和心功能NYHA、分级I～Ⅲ级。分别于麻醉诱导前（T1，基础状态）、切皮前（T2）、切皮后10min（T3）、30min（T4）、给予鱼精蛋白后10min（T5）、术毕（T6）、术后24h（T7）时采集动脉血样，测定血浆VP及AngⅡ的浓度。记录患者围术期临床资料。根据术中血浆VP浓度的不同，采用系统聚类分析方法将患者分为高值组（n=26）和低值组（n=24）。采用logistic回归分析筛选低血VP浓度的危险因素。结果与高值组比较，低值组T2～T6时血浆VP浓度降低，血浆AngⅡ浓度升高，术中血管麻痹发生率升高，术中及术后扩血管药物使用率降低，气管导管拔除时间、ICU停留时间和术后住院时间延长，术前左室射血分数（LVEF）降低（P〈0．05或0．01）。logistic回归分析结果表明，术前低LVEF是术中低血VP浓度的危险因素，比值比为1．122（P〈0．01）。结论非CPB冠状动脉旁路移植术患者术中血VP和AngⅡ浓度变化趋势相反；低血VP浓度患者术中血管麻痹发牛率升高．术后转归较尊：术前低LVEF是术中低向VP浓摩的毹除因素．Objective To investigate the relationship between the changes in perioperative plasma vaso- pressin （VP） and angiotensin II （ Ang II ） concentrations and outcome in patieots undergoing off-pump coronary artery bypass grafting （ OPCABG）. Methods Fifty AsA I - 111 patients （ NYHA I - III ） of both sexes, aged 45-79 yr, undergoing OPCABG, were enrolled in this study. Blood samples were collected before induction of anesthesia （T1 ,baseline）, before skin incision （T2）, at 10 and 30 ruin after skin incision （T3 , T4 ）, 10 min after protamine injection （T5） , end of operation （T6 ） and 24 .h after operation （T7） ; Based on the intraoperative plasma VP concentrations, the patients were divided into high level group （ n = 26） and low level group （ n = 24） by hierarchical clustering analysis. The risk factors for perioperative lower plasma VP concentration were determined by logistic re- gression analysis. Results Plasma VP concentrations were significantly lower, while plasma Ang ]l concentrations were significantly higher at T2-6 in the low level group than in the high level group. The incidence of vasoplegia （high cardiac output and low peripheral resistance） was significantly higher, the intra- and post-operative use of vasodilator was less, the tracheal extubation time, ICU stay and post-operative hospital stay were longer, and preoperative left ventricular ejection fraction （LVEF） was lower in low level group than in high level group. Logistic regression analysis showed that preoperative low LVEF was a risk factor for intraoperative low plasma VP concentra- tion and OR was 1. 122. Conclusion Plasma VP and Ang II concentrations demonstrate an opposite trend of change during OPCABG. The incidence of vasoplegic syndrome is significantly higher and the outcome poor in low plasma VP group. Preoperative low LVEF is a risk factor for development of low plasma VP during OPCABG.

关 键 词：血管升压素类 血管紧张素Ⅱ 预后 冠状动脉旁路移植术 非体外循环 

分 类 号：R654.2[医药卫生—外科学]