冠状动脉旁路移植术中应用罂粟碱对即时静脉桥血管影响的研究  

Effect of papaverine on instant venous graft in off-pump coronary artery bypass grafting

作　　者：赵铁夫[1] 王盛宇[1] 张春晓[1] 张明[1] ZHAO Tiefu;WANG Shengyu;ZHANG Chunxiao;ZHANG Ming(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科

出　　处：《心肺血管病杂志》2019年第8期848-850,860,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨冠状动脉旁路移植(OPCAB)术中应用罂粟碱处理静脉桥血管对围术期的影响。方法:选择2015年1月至2018年12月,在首都医科大学附属北京安贞医院心脏外科,单一手术组行OPCAB手术的患者251例作为罂粟碱组,其中男性150例,女性101例,平均年龄(67. 44±7. 49)岁,术中静脉桥血管排气液应用1. 5 mg/m L罂粟碱溶液。选择同期OPCAB手术的患者172例作为对照组,其中男性96例,女性76例,平均年龄(68. 91±7. 05)岁,术中静脉桥血管排气液为室温0. 9%氯化钠溶液。比较两组临床结果。结果:全部患者无围术期死亡。罂粟碱组术中平均流量(MGF)[(43. 91±8. 82) vs.(41. 21±6. 30) m L/min,t=2. 557,P=0. 011]高于对照组,搏动指数(PI)[(3. 03±0. 48) vs.(3. 57±0. 45),t=-7. 860,P=0. 000]、入ICU 30 min中心静脉压[(7. 42±2. 47) vs.(9. 04±3. 15) mm Hg,t=-2. 514,P=0. 032]、术后肾上腺素用量[(0. 07±0. 02) vs.(0. 08±0. 03)μg·kg-1·min-1,t=-4. 934,P=0. 000]、去甲肾上腺素用量[(0. 07±0. 02) vs.(0. 06±0. 02)μg·kg-1·min-1,t=2. 030,P=0. 044]、及Tn I值[(0. 48±0. 37) vs.(0. 68±0. 54) ng/min,t=-2. 820,P=0. 006]均少于对照组。结论:OPCAB术中应用罂粟碱对静脉桥血管予以处理,可以增加静脉桥血管即时平均血流量,减低搏动指数,减少围术期心肌损伤,此方法适于在OPCAB术中推广使用。Objective: To investigate the effect of papaverine treatment of venous graft in off-pump coronary artery bypass grafting( OPCAB) on perioperative period. Methods: Totally 251 patients were selected as a papaverine group,who underwent OPCAB in the single operation group of Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2015 to December 2018. There were 150 males and 101 females with an average age of( 67. 44±7. 49) years. 1. 5 mg/m L papaverine solution were used in venous graft exhaust fluid in operation. While 172 patients with the same condition during the same period were selected as a control group. There were 96 males and 76 females with an average age of( 68. 91± 7. 05) years. Normal saline were used in venous graft exhaust fluid in operation. Results: No perioperative death occurred in all patients. MGF[( 43. 91±8. 82) vs.( 41. 21±6. 30) m L/min,t=2. 557,P=0. 011]in papaverine group was higher than that in control group,PI [( 3. 03 ± 0. 48) vs.( 3. 57 ± 0. 45),t =-7. 860,P = 0. 000 ],central venous pressure 30 minutes after treated in ICU [( 7. 42 ± 2. 47) vs.( 9. 04 ± 3. 15) mm Hg,t =-2. 514,P = 0. 032],epinephrine dosage [( 3. 03±0. 48) vs.( 3. 57± 0. 45)μg·kg-1·min-1,t =-7. 860,P = 0. 000]in postoperative,norepinephrine dosage[( 0. 07±0. 02) vs.( 0. 06±0. 02)μg·kg-1·min-1,t= 2. 030,P= 0. 044]in postoperative and Tn I [( 0. 48±0. 37 vs.( 0. 68±0. 54) ng/m L,t =-2. 820,P = 0. 006] were less than those of the control group.Conclusions: Papaverine treatment of venous graft during OPCAB can increase the instant mean blood flow ofvenous graft,reduce pulsation index and reduce perioperative myocardial injury. This technique is suitable for popularization in OPCAB.

关 键 词：冠状动脉旁路移植术 非体外循环 罂粟碱 

分 类 号：R54[医药卫生—心血管疾病]