多巴酚丁胺或米力农对CPB心脏瓣膜置换术患者心室内同步化的影响  

Effect of dobutamine or milrinone on intraventricular synchronization in patients undergoing cardiac valve replacement with cardiopulmonary bypass

作　　者：王亭亭[1] 史宏伟[1] 魏海燕[1] 卜心怡 葛亚力[1] 苏中宏[1] 施韬[1] Wang Tingting;Shi Hongwei;Wei Haiyan;Bu Xinyi;Ge Yali;Su Zhonghong;Shi Tao(Department of Anesthesiology,Nanjing Hopsital Affiliated to Nanjing Medical University (Nanjing First Hospital),Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉科,210006

出　　处：《中华麻醉学杂志》2018年第7期789-792,共4页Chinese Journal of Anesthesiology

摘　　要：目的 评价多巴酚丁胺或米力农对CPB心脏瓣膜置换术患者心室内同步化的影响.方法 择期首次行CPB心脏瓣膜置换术患者60例,性别不限,年龄40~75岁,ASA分级Ⅱ或Ⅲ级, NYHA心功能分级Ⅱ或Ⅲ级.采用随机数字表法分为3组(n=20):对照组(C组)、多巴酚丁胺组( D组)和米力农组(M组).停机后15 min时,D组静脉输注多巴酚丁胺4 μg·kg-1·min-1,M组静脉输注米力农0.4 μg·kg-1·min-1,持续60 min,C组于同时点静脉输注等容量生理盐水.经食管超声心动图监测心功能指标.于麻醉诱导后开胸前(T0)、CPB停机后15 min(T1)、输注多巴酚丁胺、米力农或生理盐水30和60 min(T2,取两个时点的平均值)时采用QLAB软件(9.1版本)线下计算心室内同步化指标:左心室纵向7个节段达峰时间的标准差(LVSDt-L)、右心室纵向7个节段达峰时间的标准差(RVSDt)、左心室短轴6个节段达峰时间的标准差(LVSDt-C).结果 与C组比较,D组T2时LVSDt-C、LVSDt-L和RVSDt降低(P<0. 05),M组各时点上述指标差异无统计学意义(P>0. 05);与D组比较,M组T2时RVSDt升高(P<0. 05);与T0时比较,C组T2时LVSDt-L升高,M组T2时RVSDt升高(P<0. 05).结论 CPB后静脉输注多巴酚丁胺可改善心脏瓣膜置换术患者心室内同步化运动,而米力农可能增加右心室非同步化运动.Objective To evaluate the effect of dobutamine or milrinone on intraventricular synchronization in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods Sixty American Society of Anesthesiologists physical status l[or m patients of both sexes, aged 40-75 yr,of New York Heart Association Ⅱ or Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 3groups (n=20each)using a random number table:control group (group C),dobutamine group (group D)and milrinone group (group M).Dobutamine 4μg·kg^-1·min^-1 was intravenously infused for 60min starting from 15min after termination of CPB in group D.Milrinone 0.4μg·kg^-1·min^-1 was intravenously infused for 60min starting from 15min after termination of CPB in group M.The equal volume of normal saline was given instead in group C.The parameters of heart function were monitored using transesophageal echocardiography.After induction of anesthesia and before splitting the sternum (T0),at 15min after termination of CPB (T1),and at 30and 60min of dobutamine,milrinone or normal saline infusion (T2,average value at two time points),the parameters of intraventricular synchronization were calculated with QLAB software (9.1version):standard deviation of time to peak systolic velocity of the left ventricular longitudinal strain 7segments (LVSDt-L),standard deviation of time to peak systolic velocity of the right ventricular longitudinal strain 7segments (RVSDt),standard deviation of time to peak systolic velocity of the left ventricular circumferential strain 6 segments (LVSDt-C).Results Compared with group C,LVSDt-C,LVSDt-L and RVSDt were significantly decreased at T2 in group D (P< 0.05),and no significant change was found in the indices mentioned above at each time point in group M (P>0.05).RVSDt was significantly higher at T2in group M than in group D (P<0.05).Compared with the baseline at To,LVSDt-L was significantly increased at T2in group C,and RVSDt was significantly increased at T2in group M (P<0.05).Conclu

关 键 词：多巴酚丁胺 米力农 心脏瓣膜假体植入 心肺转流术 心室 

分 类 号：R614[医药卫生—麻醉学]