艾司洛尔对先天性心脏病患儿心肌保护作用的临床研究  

Clinical efficacy of esmolol on myocardial protection in pediatrics with congenital heart disease

作　　者：穆亚宁[1] 白进[2] 黄彩虹[2] 张孝兴[3] 

机构地区：[1]宝鸡市妇幼保健院儿科,宝鸡721000 [2]陕西榆林市第一医院儿科,榆林718000 [3]陕西宝鸡市妇幼保健院儿童医院,宝鸡721000

出　　处：《新医学》2016年第9期628-632,共5页Journal of New Medicine

摘　　要：目的研究艾司洛尔对先天性心脏病患儿的心肌保护作用。方法选取择期行先天性心脏病手术的90例患儿为研究对象,随机分为A、B组,每组各45例。术中A组患儿每1 L的St.Thomas'Ⅱ心脏停搏液中另加入1.5 ml艾司洛尔(规格为250 mg/ml),B组患者则加入相同容量的生理盐水。记录患儿术后前4 h的收缩压、中心静脉压(CVP)、心率、多巴胺及肾上腺素使用量。监测患儿术后第1日和第1周的LVEF和心输出量。结果 2组患者的体外循环时间、拔管时间及ICU停留时间比较差异均无统计学意义(P均﹥0.05)。A组有39例(87%)患儿术后使用强心药,使用强心药比例低于B组45例(100%,P=0.026)。在手术过程中,A组的CK-MB水平为(92.1±2.1)U/L,低于B组的(110.9±4.5)U/L(P﹤0.05)。另外,A组术后1周的LVEF及心输出量高于B组(P均﹤0.05)。结论艾司洛尔对先天性心脏病患儿具有较好的心肌保护作用,能够减少患儿术后强心药的使用,降低心肌损伤程度并增加患者术后1周的LVEF和心输出量。Objective To evaluate the clinical efficacy of esmolol on myocardial protection in pediatrics diagnosed with congenital heart disease. Methods Ninety pediatric patients scheduled to undergo the surgery of congenital heart disease were chosen and randomly divided into groups A and B（n =45 for each group）. For the patients in the group A, 1. 5 ml of esmolol at a dose of 250 mg/ml was supplemented to 1L of St. Thomas’ Ⅱ solution, and an equivalent quantity of normal saline was added in the group B. Systolic arterial blood pressure, central venous pressure （ CVP） , heart rate, the administration amount of dopamine and epinephrine were recorded within 4 h after surgery. Left ventricle ejection fraction （ LVEF） and cardiac output （CO） were measured at 1 d and 1 week following surgery. Results There was no significant difference in the cardiopulmonary bypass, time of extubation and length of ICU stay between two groups （all P 〉0. 05）. In the group A, 39 patients （87%） were administered with the inotrope after surgery, significantly lower than 45 （100%） ） in the group B （ P = 0. 026 ）. Intmopemtively,the CK-MB level in the group A was （ 92. 1 ± 2. 1 ） U/L,significantly lower compared with （110. 9 ±4. 5） U/L in the group B （ P 〈 0. 05 ） . Furthermore, the LVEF and CO in the group A were considerably higher than and in the group B at postoperative 1 week （both P 〈 0. 05 ） . Conclusions Esmolol exerts effective effect upon myocardial protection in pediatrics with congenital heart disease, which can reduce postoperative use of inotrope, mitigate the severity of myocardial damage and increase the LVEF and CO at postoperative 1 week.

关 键 词：艾司洛尔 先天性心脏病 儿童 心肌保护 

分 类 号：R725.4[医药卫生—儿科]