米力农对体外循环期间胃肠灌注的影响  

Effect of milrinone on gastrointestinal perfusion during cardiopulmonary bypass

作　　者：陈艳平[1] 曹德权[1] 明豫军[1] 常业恬[1] 

机构地区：[1]中南大学湘雅第二医院麻醉科,长沙市410011

出　　处：《中华麻醉学杂志》2001年第11期656-658,共3页Chinese Journal of Anesthesiology

摘　　要：目的　研究米力农对体外循环期间胃粘膜 pH值 (pHi)、内毒素血症及全身炎症反应的影响。方法　选择 2 0例风心病心内直视瓣膜置换术病人 ,诱导后插入胃管 ,吸尽胃内容物 ,注入无菌生理盐水 30ml后夹闭胃管。将病人随机分为米力农组 (M组 )和对照组 (C组 ) ,M组给予米力农30 μg·kg- 1 负荷量静注 ,而后用微泵 0 5 μg·kg- 1 ·min- 1 维持。负荷量后 30min(T0 ) ,转流后 30min(T1 ) ,停机后 30min(T2 ) ,术后 6h(T3 )取胃液在血气分析仪上测胃液PCO2 ,同时测动脉血HCO-3 ,根据Henderson Hasselbalch方程式算出 pHi,取静脉血测血清内毒素浓度和TNF α浓度。 结果　 (1)pHi两组T1 、T2 与T0 比差异有显著性 (P <0 0 1) ,T3 与T0 比差异无显著性 (P >0 0 5 ) ,M组与C组比 ,T0 差异无显著性 ,T1 、T2 、T3 差异均有显著性。 (2 )TNF α ,两组T1 、T2 、T3 分别与T0 比差异均有显著性 ,M组与C组比 ,T0 差异无显著性 ,T1 、T2 、T3 差异均有显著性。 (3)内毒素浓度两组T2 、T3与T0 比差异有显著性 ,T1 与T0 比差异无显著性 ,M组与C组比 ,T0 差异无显著性 ,T1 、T2 、T3 差异均有显著性。结论　米力农通过改善体外循环期间胃肠灌注 。Objective To investigate the effect of milrinone on the gastric intramucosal pH (pHi), endotoxemia and systemic inflammatory response during cardiopulmonary bypass (CPB) Methods Twenty adult patients undergoing valve replacement were randomly divided into two equal groups of ten patients each: control group (C) and milrinone group (M) In group M milrinone 30μg·kg -1 was given as an intravenous bolus after induction of anesthesia followed by 0 5μg·kg -1 ·min -1 infusion, while in group C normal saline (NS) was given instead of milrinone Patients with ejection fraction (EF) <0 5, gastrointestinal function disturbances and diabetes mellitus were excluded from this study The patients were premedicated with intramuscular morphine 0 2mg·kg -1 and scopolamine 0 006mg·kg -1 Ranitidine 1mg·kg -1 was given iv before anesthesia which was induced with midazolam 0 1mg·kg -1 , fentanyl 10μg·kg -1 and vecuronium 0 1 mg·kg -1 and maintained with fentanyl (total dose 40 50μg·kg -1 ), midazolam, vecuronium and isoflurane The patients were mechanically ventilated after tracheal intubation and P ET CO 2 was maintained at 35 45mmHg MAP, ECG, CVP, P ET CO 2, SpO 2, nasal pharyngeal and rectal temperature were monitored during operation pHi measurements were performed and venous blood samples for plasma endotoxin and TNF α determination were taken at 30 min after milrinone or NS bolus (T 0), 30 min after beginning of CPB (T 1), 30 min after weaning from CPB (T 2) and 6h after patients were admitted to ICU (T 3) Results During CPB there were gastrointestinal acidosis (pHi<7 35), endotoxemia and significant general inflammatory response In group M gastric intramucosal acidosis was less severe and plasma endotoxin and TNF α levels were lower than those in group C Conclusions Gastric intramucosal acidosis, endotoxemia and general inflammatory response occur during CPB as shown by reduced pHi and plasma endotoxin and TNF α M

关 键 词：米力农 心肺转流术 体外循环 胃肠灌注 强心药 

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