米力农对风湿性心脏病患者瓣膜置换围术期炎性反应的影响  

Influence of milrinone on systemic inflammation in perioperative patients undergoing cardiac valve replacement

作　　者：徐美英[1] 张建欣[1] 张富军[1] 沈茜[2] 

机构地区：[1]第二军医大学长海医院麻醉科,上海200433 [2]第二军医大学长海医院实验诊断科,上海200433

出　　处：《中华麻醉学杂志》2000年第8期463-466,共4页Chinese Journal of Anesthesiology

基　　金：军队医药卫生科研基金!资助项目 ;编号 :98D0 40 ;上海市青年自然基金!资助项目 ;编号 :98ZB14 0 3 6

摘　　要：目的　探讨风心病患者瓣膜置换围术期的炎性反应及米力农对其的影响。方法　 2 0例心功能Ⅱ Ⅳ级瓣膜置换术患者 ,随机分为米力农组和对照组 ,米力农组 10min内用负荷剂量米力农 30 μg/kg、继以 0 5 μg·kg 1·min 1持续静脉输注 ,对照组则以相同速率推注生理盐水。分别于麻醉诱导前 (T1)、诱导后 30min(T2 )、主动脉阻断后 30min(T3 )、主动脉开放后 10min(T4 )及 30min(T5)、CPB后 30min(T6)及 8h(T7)、和术后 2 4h(T8)及 72h(T9)采取混合静脉血 ,常规法测定白细胞(WBC)、中性粒细胞 (PMN)、淋巴细胞 (LYM)和血小板 (PLT) ;酶联免疫吸附反应技术测定IL 6、IL 8及IL 10。结果　两组T5～T9WBC、PMN、IL 6及IL 8明显升高 ,T3 ～T9IL 10也明显升高 (P <0 0 5 0 0 1) ;IL 6、IL 8、IL 10在T6达峰值 ;米力农组T5～T9IL 6显著低于对照组 ,而IL 10则显著高于对照组 (P <0 0 5 )。结论　体外循环下瓣膜置换术可导致较强而短暂的炎性反应 ,于CPB后30min达到高峰并持续至术后 72h ;Objective To investigate the influence of milrinone on systemic inflammation in the perioperative cardiac valve replacement Methods Twenty patients, scheduled for cardiac valve replacement were randomly divided into 2 groups: milrinone and control groups Before anesthesia induction, a bolus of milrinone 30μg/kg was given in 10min, followed by a continuous infusion of 0 5μg·kg 1 ·min 1 during operation in milrinone group and the same volume of saline was administrated in control group The mixed venous blood samples were obtained from the pulmonary artery at the following points : before induction of anesthesia (T 1), 30min after anesthesia (T 2), 30min after the cross clamping of aorta (T 3 ), 10min and 30min after the declamping (T 4,T 5), 30min and 8 h after CPB(T 6,T 7), 24h and 72 h after operation (T 8,T 9) IL 6, IL 8 and IL 10 were determined by enzyme linked immunosorbent assay Results Compared with those at T 1, the levels of WBC,PMN,IL 6 and IL 8 increased significantly from T 5 to T 9, and IL 10 level rose markedly from T 3 to T 9 (P<0 05 or 0 01) in both groups IL 6 , IL 8 and IL 10 levels reached the peak at T 6 Compared with those in control group, IL 6 level decreased obviously (P<0 05) in milrinone group from T 5 to T 9, while IL 10 level increased markedly (P<0 05) , but IL 8 level remained unchanged significantly (P>0 05) Conclusions During CPB and cardiac valve replacement the systemic inflammation is obvious , reaches the peak 30 min after CPB and persists to 72h after operation Perioperative administration of low dose milrinone is effective against the inflammation

关 键 词：风湿性心脏病 心脏瓣膜置换 米力农 炎性反应 

分 类 号：R654.2[医药卫生—外科学]