不同途径输注鱼精蛋白对先天性心脏病合并肺动脉高压患者体外循环术后血流动力学的影响  

Hemodynamic effects of protamine different infusion ways on the congenital heart disease patients with pulmonary hypertension after extracorporeal circulation surgery

作　　者：任旭东[1] 杨彦博[1] 张巧燕[1] 宋兵[1] 

机构地区：[1]兰州大学第一医院心血管外科,730000

出　　处：《中国现代医药杂志》2012年第10期12-15,共4页Modern Medicine Journal of China

摘　　要：目的 探讨不同途径输注鱼精蛋白对先天性心脏病合并肺动脉高压患者体外循环术后血流动力学的影响。方法选择手术治疗先天性心脏病患者80例,根据不同给药途径(主动脉、中心静脉)及有无肺动脉高压分为4组,每组20例:A1组(无肺动脉高压、主动脉给药)、A2组(无肺动脉高压、中心静脉给药)、B1组(肺动脉高压、主动脉给药)、B2组(肺动脉高压、中心静脉给药)。记录术前(T0)、输注鱼精蛋白之前(T1)、输注后1min(T2)、3min(T3)、5min(T4)、10min(T5)、15min(T6)、25min(T7)各时间点HR、SBP、MAP、CVP等参数,并采静脉血测血清中各时间点组胺的水平。结果输注鱼精蛋白后,经中心静脉给药A2组及B2组MAP、RPP(RH×SBP)均低于主动脉给药A1组(P<0.05)及B1组(P<0.01);B2组CVP明显高于B1组(P<0.05)。给药后(T2～T7)4组患者血中组胺浓度较术前(T0)均明显升高(P<0.05),经中心静脉给药A2组及B2组较主动脉给药A1组及B1组升高更为显著(P<0.01)。结论先天性心脏病术后经主动脉输注鱼精蛋白可减少组胺的释放;主动脉给药对体外循环术后患者的血流动力学影响较小,特别是合并有肺动脉高压的患者。Objective To investigate the hemodynamic effects of protamine different infusion ways on the congenital heart disease （CHD） patients with pulmonary hypertension（PH） after extraeorporeal circulation（ECC） surgery. Methods Selected 80 cases of the CHD patients prepared for ECC surgery, according to the different routes of administration and with or without PH were divided into four groups （n=20）：A1（non-PH, aortic root administration）, AE（non-PH, central venous administration）, BI（PH, aortic root administration）, B2（PH, central venous administration）. Recorded the preoperative（T0）, before infusion of protamine （T1）, 1 minute after infusion of protamine （T2）, 3 minutes （T3）, 5 minutes （T4）, 10 minutes （Ts）, 15 minutes （T6） and 25 minutes （T7） all time points HR, SBP, MAP and CVP. Collected the venous blood specimen to detect the histamine. Results After infusion protamine, the MAP and RPP（RHxSBP） of group A2 and group B2 were lower compared to group A1（P〈0.05） and group BI（P〈0.01）; the CVP of group B2 was higher compared to group BI（P〈0.05）. After infusion pro- tamine （T2 to T7）, the histamine in four groups all obviously increased compared to preoperation （To） ,P〈0.05 ; the HC of group A2 and group BE increased more significantly compared to group Al （P〈0.01） and group B1 （P〈0.01）. Conclusion Patients with CHD after ECC surgery infusion protamine through the aortic root can significantly reduce the histamine release compared with central vein administration.h also have a slightly effects on hemodynamics in patients after ECC surgery compared with central vein administration, especially in the CHD patients with PH.

关 键 词：血流动力学 先天性心脏病 肺动脉高压 鱼精蛋白 体外循环 

分 类 号：R654.2[医药卫生—外科学]