米力农对瓣膜置换术患者血流动力学的影响  

Hemodynamic effects of milrinone in patients undergoing valve replacement

作　　者：张建欣[1] 徐美英[1] 张富军[1] 杜健儿[1] 

机构地区：[1]第二军医大学长海医院麻醉科,上海200433

出　　处：《第二军医大学学报》2000年第12期1172-1174,共3页Academic Journal of Second Military Medical University

基　　金：军队医药卫生科研基金! (98D0 40 );上海市青年科学基金!(98ZB14 0 36 )

摘　　要：目的 :观察风湿性心脏病患者瓣膜置换术中应用米力农对其血流动力学及预后的影响。 方法 :2 0例风湿性心脏病瓣膜置换术患者 ,随机分为 A,B两组 :A组在麻醉诱导前 10 min内给予负荷剂量米力农 30μg/ kg、继以 0 .5μg/ (kg· min)的速度微泵持续静推 ;B组以相同速度推注生理盐水。分别于给予负荷剂量米力农前、后 ,麻醉诱导后、锯胸骨后、体外循环(CPB)结束时 ,关胸前、后测取血流动力学指标 ;记录液体出入量、机械通气时间、ICU留滞及术后住院时间。 结果 :(1)应用负荷剂量米力农后 ,A组与 B组相比 :CI,L VSWI明显增加 (P<0 .0 5 ) ,PAP,CVP,SVR,PVRI下降明显 (P<0 .0 5 ) ,HR及MAP无明显变化 (P>0 .0 5 ) ;其中两组 CI,L VSWI,SVR的显著差异一直持续至 CPB结束后。 (2 ) A组 CPB前的胶体入量显著多于 B组。 (3) A组 CPB中缩血管药物用量高于 B组。结论 :应用负荷剂量米力农可明显增加心脏指数和左心室收缩功指数 ,同时可降低肺动脉压和心脏的前后负荷 。Objective: To evaluate the hemodynamic and prognostic effects of milrinone in patients undergoing valve replacement throughout the process of operation. Methods: Twenty patients undergoing valve replacement were radomized into group A ( n =10) and group B ( n =10).Before induction of general anesthesia, milrinon was administered at a 30 μg/kg bolus dose intravenously in 10 min, followed by a continuous infusion of 0.5 μg/(kg·min) in group A, and the same volume of normal saline in group B. The parameters of hemodynamics were obtained at the following points: before and after loading dose of milrinone, after induction of general anesthesia, after opening the chest, after weaning of CPB, before and after shutting of the sternum. The time of ICU stay and quantity of fluid in and out were calculated. Results: (1) After loading dose of milrinon, CI, LVSWI in group A were significantly higher, while PAP, CVP, SVR and PVRI were significantly lower than the same point of group B. CI, LVSWI and SVR in two groups remained significant different at the other points. (2) Patients in group A had more colloed and norepinephrine infusion than group B. Conclusion: Administration of milrinone at loading dose can effectively increase cardiac output and left ventricular stroke work, and decrease pulmonary artery pressure, pulmonary and system vascular resistance. [

关 键 词：米力农 心脏瓣膜置换术 血流动力学 强心药 

分 类 号：R654.2[医药卫生—外科学] R972.1[医药卫生—临床医学]