氯化钾注射液在体外循环手术患者心脏复跳中的应用研究  

Study on the application of potassium chloride injection in cardiac recovery in patients undergoing extracorporeal circulation

作　　者：钱晓亮[1] 赵健[1] 程兆云[1] 

机构地区：[1]郑州大学人民医院心血管外科,450008

出　　处：《中国老年保健医学》2017年第4期41-43,共3页Chinese Journal of Geriatric Care

基　　金：河南省科技厅科技攻关项目(编号:162102310031)

摘　　要：目的探讨氯化钾注射液在体外循环患者开放升主动脉后心脏复跳前的应用方法,提高手术患者的自动复跳率。方法择期行双瓣置换术且在开放升主动脉后均出现不同程度的心室颤动患者40例,性别不限,年龄40~72岁,体重56~82kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其分为2组(n=20):生理盐水组(C组)和氯化钾组(K组)。K组于患者手术开放升主动脉后心电图出现室颤波形后从膜肺静脉端快速推注10%氯化钾溶液1g。C组用等容量的生理盐水代替。分别于诱导后切皮前(T_1)、体外循环开始后30分钟(T_2)、开放升主动脉前5分钟(T_3)、心脏复跳后5分钟(T_4)、体外循环结束前5分钟(T_5)、体外循环结束后10分钟(T_6)、手术结束后4小时(T_7)时记录HR,MAP,CVP,CO,SVR并采集桡动脉血样5ml,取2ml行血气分析,余3ml抗凝后离心,置于-80℃冰箱保存,采用ELISA法测定血浆CK-MB水平。记录两组患者心脏自动复跳情况。结果与T_1时比较,T_(2-4)时Hb浓度降低,T_5时K^+浓度升高,T_(6-7)时GLU与LAC浓度升高,T_(4-7)时血浆CK-MB浓度升高(P<0.05);与C组相比,K组T_4时K^+浓度升高(P<0.05);与C组比较,K组心脏自动复跳率明显增加(P<0.05)。结论在体外循环下行心脏直视手术患者,开放升主动脉出现心室颤动后,快速推注氯化钾能够快速除颤,提高患者的自动复跳率。Objectives To explore the application of potassium chloride injection in extracorporeal circulation in patients with open ascending aorta and to improve the automatic recurrence rate. Methods Forty ASA physical status II or m patients of both sexes, aged 40- 72 yr, weighing 56 -82kg, scheduled for double-valve replacement with varying degrees of ventricular fibrillation in open ascending aorta, were randomly divided into 2 groups （ n = 20 each ） ： control group （ C group ） and potassium chloride injection group（ K group）, the patients of K group was rapidly promoted from the membrane pulmonary vein to lg of potassium chloride when the ventricular fibrillation of the ventricular fibrillation （eegs） of the ventricular fibrillation （ekg） after the patient underwent surgery, and the patients of C group were given intravenously with equivalent normal saline at the same time. Blood samples were obtained from radial artery before cutting the skin （T1） ,30min after the extracorporeal cycle begins（CPB） （T2 ） ,5min before opening the as- tending aorta （T3 ） ,5min after the heart resuscitation （T4 ） ,5min before the end of CPB （T5 ）, 10min after the end of CPB （T6 ） and 4h after the end of the operation for determination of HR,MAP,CVP,CO,SVR and the plasma CK-MB concentrations and the cardiac autoreactivity of the two groups was recorded. Results Compared with T1, the concentration of Hb at the time of T2-4 was significantly increased, the concentration of K^ ＋ was increased at the time of T5 , the concentration of GLU and LAC were increased at T6-7 , and the plasma CK-MB concentration was increased at T4-7 （P 〈0. 05）. Compared with group C, K^＋ concentration was increased in the group of K （ P 〈 0.05 ）. Compared with group C, the automatic rate of cardiac recovery in K group was increased sig- nificantly （ P 〈 0. 05 ）. Conclusion After the open ascending aorta showed ventricular fibrillation, the rapid infusion of potassium chloride could quickly remov

关 键 词：体外循环 氯化钾注射液 心脏除颤 

分 类 号：R654.1[医药卫生—外科学]