米力农对心脏瓣膜置换手术患者心肺转流后血流动力学的影响  

Hemodynamic effects of milrinone after aortic declamping during cardiopulmonary bypass in patients underwent cardiac valve surgery

作　　者：徐志荣[1] 方能新[1] 曾一平[1] 张健[1] 钱梅[1] 颜莉[1] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,合肥230022

出　　处：《安徽医科大学学报》2002年第4期297-300,共4页Acta Universitatis Medicinalis Anhui

摘　　要：目的　比较米力农在心肺转流心脏瓣膜置换手术的麻醉中对血流动力学的影响。方法　随机、双盲将择期换瓣手术患者 2 0例分为 2组 ,1组为米力农组 (M组 ) ,另 1组为控制组 (C组 ) ;每组 10例。M组在主动脉阻断钳开放后立即静脉输入米力农负荷量 5 0 μg/kg ,10min内输完 ;继之以静脉注入维持量米力农 0 2 μg/ (kg·min) ;C组以同样方法注入安慰剂。记录主动脉开放后患者生命体征变化情况及正性变力药多巴胺、肾上腺素的用量。正性变力药的使用以保持患者平均动脉压不低于 6 7kPa为标准。结果　在主动脉开放后 30min内 ,多巴胺的用量两组差异没有显著性(P >0 0 5 ) ;在主动脉开放后 90min的围麻醉期内其它时间段 ,肾上腺素和多巴胺的用量M组小于C组 (P <0 0 1)。两组主动脉开放后的收缩压 (SB)、舒张压 (DB)差异无统计学意义 (P >0 0 5 ) ;M组心率 (HR)快于C组 (P <0 0 5 )。Objective To compare the hemodynamic effects of mil rinone after aortic declamping during car diopulmonary bypass (CPB) in patients underwent cardiac valve surgery. Methods Twenty patients scheduled for cardiac valve surgery were divided into 2 groups by randomized,double blind grouping:(1) milrinone group(M). (2)controlled group(C). Patients received a loading dose of 50 microg/kg of milrinone followed by an introvenous infusion of 0.2 microg/(kg·min) or placebo immediately after the relieve of aortic clamp ing. The requirement for vasoactive medication (epinephrine or dopamine) was set at mean arterial pressure 50 mmHg. Hemodynamic data were comparable in both groups at each time of measurement. Hemodynamic measurements were performed befo re CPB,and at 0, 5, 10, 15, 20, 25, 30, 40, 50, 60, 70, 80, 90 minutes after aortic declamping vasoactive medication was recorded. Results There was no significant differences. in dopamine requirement in the first 30 minutes immiduate after aortic declamping between the two groups,but significant reduction in dopamine use after 30 minutes, 60 minutes and 90 minutes. The mean postoperattion heart rate was faster in group M than in group C ( P <0 05). Significant reduction in adrenaline use was found 15, 30, 60 and 90 minutes after administration of milrinone ( P <0 01). No remarkable adverse effect was found in the study. There was no significant difference in the changes of blood pressure ( P >0 05) in the control group as compared with the milrinone group. Conclusion Milrinone is effective in keeping hemodynamic stability foll owing CPB in patients underwent cardiac valve surgery and in reducing vasoactive medication requirement.

关 键 词：米力农 药理学 人工心脏瓣膜 血液动力学 药物作用 

分 类 号：R654.2[医药卫生—外科学]