尼可地尔对体外循环下心脏瓣膜置换术患者心功能的影响:血清氨基末端脑钠肽前体浓度检测  

Effect of nicorandil on cardiac function in patients undergoing cardiac valve replacement under cardiopulmonary bypass:detection of amino-terminal pro-brain natriuretic peptide concentrations in serum

作　　者：冯典 方开云[2] 高敏 刚绍鹏[2] 何祥[2] 蒋玲 刘秀伦[3] 向道康[3] Feng Dian;Fang Kaiyun;Gao Min;Gang Shaopeng;He Xiang;Jiang Ling;Liu Xiulun;Xiang Daokang(Department of Anesthesiology,The Third Affiliated Hospital of Zunyi Medical University(Zunyi First People′s Hospital),Zunyi 563000,China;Department of Anesthesiology,Guizhou People′s Hospital,Guiyang 550002,China;Department of Cardiology,Guizhou Provincial People′s Hospital,Guiyang 550002,China)

机构地区：[1]遵义医科大学第三附属医院(遵义市第一人民医院)麻醉科,563000 [2]贵州省人民医院麻醉科,贵阳550002 [3]贵州省人民医院心外科,贵阳550002

出　　处：《中华麻醉学杂志》2020年第1期35-39,共5页Chinese Journal of Anesthesiology

基　　金：贵州省科技计划项目(黔科合基础[2016]1089,黔科合支撑[2019]2815)贵州省人民医院博士基金(GZSYBS[2015]05)。

摘　　要：目的评价尼可地尔对体外循环下心脏瓣膜置换术患者心功能的影响。方法择期全麻体外循环下行心脏瓣膜置换术患者40例,年龄18~64岁,ASA分级Ⅱ-Ⅳ级,NYHA心功能分级Ⅱ或Ⅲ级,BMI 18~25 kg/m2,性别不限,采用随机数字表法分为2组(n=20):常规组和尼可地尔组。尼可地尔组于麻醉诱导后静脉输注尼可地尔10~60μg·kg^-1·h^-1至术毕。2组维持平均动脉压60~80 mmHg。分别于麻醉诱导前(T0)、术后6、12、24、48和72 h(T1-5)、出院(T6)时采集静脉血样,测定血清氨基末端脑钠肽前体(NT-proBNP)浓度。记录术前及术后心肌缺血事件或心律失常的发生情况;记录术中心脏复跳时除颤情况、自动复跳情况、复跳时用药情况和复跳后心脏节律;记录术中及术后心血管活性药物的使用情况。记录机械通气时间和ICU停留时间。结果与常规组比较,尼可地尔组T5和T6时血清NT-proBNP浓度降低,机械通气时间和ICU停留时间缩短,术中去甲肾上腺素及术后多巴酚丁胺使用量减少(P<0.05),术后心肌缺血事件或心律失常的发生率及术中心脏复跳时除颤率、自动复跳率、复跳后心脏节律、复跳时用药率比较差异无统计学意义(P>0.05)。结论术中静脉输注尼可地尔可改善体外循环下心脏瓣膜置换术患者心功能,有助于改善短期预后。Objective To evaluate the effect of nicorandil on cardiac function in the patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Forty patients of both sexes,aged 18-64 yr,of American Society of Anesthesiologists physical statusⅡ-Ⅳ,with New York Heart Association classⅡorⅢ,with body mass index of 18-25 kg/m2,scheduled for elective cardiac valve replacement under general anesthesia and CPB,were divided into conventional group(n=20)and nicorandil group(n=20)according to a randomized number table method.In nicorandil group,nicorandil 10-60μg·kg^-1·h^-1 was intravenously infused starting from the end of anesthesia induction until the the end of operation.Mean arterial pressure was maintained at 60-80 mmHg in two groups.Venous blood samples were collected before induction of anesthesia(T0)and at 6,12,24,48 and 72 h after operation(T1-5)and at the time of discharge(T6)to determine the serum amino-terminal pro-brain natriuretic peptide(NT-proBNP)concentrations.The occurrence of myocardial ischemic events or arrhythmia before and after operation was recorded.The defibrillation during intraoperative restoration of spontaneous heart beat,restoration of spontaneous heart beat,medication during restoration of spontaneous heart beat,and cardiac rhythm after restoration of spontaneous heart beat were recorded.The intra-and post-operative requirements for cardiovascular drugs were recorded.The mechanical ventilation time and intensive care unit stay time were also recorded.Results Compared with conventional group,the serum NT-proBNP concentration was significantly decreased at T5 and T6,the mechanical ventilation time and intensive care unit stay time were shortened,the consumption of intraoperative norepinephrine and postoperative dobutamine was decreased(P<0.05),and no significant change was found in the incidence of postoperative myocardial ischemic events or arrhythmias,defibrillation rate during restoration of spontaneous heart beat,rate of spontaneous recovery of heart beat,card

关 键 词：尼可地尔 心肺转流术 心脏瓣膜假体植入 心脏功能试验 

分 类 号：R65[医药卫生—外科学] R614[医药卫生—临床医学]