术后多次小剂量甘露醇缓慢静滴对体外循环下心脏手术患者心肺功能及临床安全性的影响  

Effects of multiple low-dose mannitol slow intravenous infusions on cardiopulmonary function and clinical safety in patients undergoing cardiac surgery under cardiopulmonary bypass

作　　者：郭浩[1] 师启众[1] 曹在新 李温斌[3] 王可强 何亚梅[1] 张保全[1] 赵冬冬 赵琪 GUO Hao;SHI Qizhong;CAO Zaixin;LI Wenbin;WANG Keqiang;HE Yamei;ZHANG Baoquan;ZHAO Dongdong;ZHAO Qi(Department of Cardiac Sugery,The Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453000,China)

机构地区：[1]新乡医学院第三附属医院心外科,453000 [2]获嘉县人民医院 [3]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外科

出　　处：《心肺血管病杂志》2022年第9期984-990,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：河南省医学科技攻关计划(联合共建)项目(LHGJ20190488)。

摘　　要：目的:探讨术后多次小剂量甘露醇缓慢静滴对体外循环下心脏手术患者心肺功能及临床安全性的影响。方法:前瞻性,连续性纳入体外循环下心脏外科手术患者共62例;采用随机数字法分为常治疗组(C组)29例,甘露醇治疗组(M组)33例。C组按术后常规治疗措施进行;M组在常规治疗基础上,分别于术后1h、8h及24h静脉滴注20%甘露醇注射液0.25g/kg,每次静滴速度5mL/min。根据两组治疗期间血流动力学参数变化、尿量变化、机械通气时间、ICU停留时间、以及对肾功能影响,分析小剂量甘露醇缓慢应用的临床效果及安全性。结果:①血流动力学变化:M组内每次使用甘露醇前后:CI、SVI均显著升高,差异有统计学意义(P<0.01);SVRI呈下降趋势,且每次使用甘露醇后变化均差异有统计学意义(P<0.01);PAWP、Lac术后先升高,后降低,甘露醇使用前后其变化均有统计学意义(P<0.05);RAP、MPAP首次使用甘露醇后变化差异无统计学意义,但后两次使用甘露醇前后变化差异有统计学意义(P<0.05)。对各组血流动力学参数进行重复测量数据的方差分析,其结果均P<0.01。②尿量变化:M组每次使用甘露醇后尿量均明显增加,其变化差异有统计学意义(P<0.01);③两组在机械通气时间、ICU停留时间均差异有统计学意义(P<0.05)。④两组对尿素、肌酐的影响差异无统计学意义(P>0.05)。结论:①术后多次小剂量甘露醇缓慢应用有利于提高心输出量、降低外周循环阻力、减轻肺水肿、改善肺顺应性、改善组织代谢、促进心功能恢复;②有利于缩短机械通气、缩短ICU停留时间;③对肾功能无损害。Objective: To investigate the effect of multiple low-dose mannitol slow intravenous infusion on cardiopulmonary function and clinical safety in patients undergoing cardiac surgery under cardiopulmonary bypass. Methods: A total of 62 patients undergoing cardiac surgery under cardiopulmonary bypass were prospectively and consecutively enrolled;they were randomly divided into the usual treatment group(group C)with 29 cases and the mannitol treatment group(group M) with 33 cases. Group C was given routine treatment after operation;group M was given 20% mannitol injection 0.25g/kg intravenously at 1 hour, 8 hours, and 24hours after operation on the basis of conventional treatment, at a rate of 5ml each time./min. The clinical effect and safety of slow application of low-dose mannitol were analyzed according to the changes of hemodynamic parameters, urine volume, mechanical ventilation time, ICU stay time, and effects on renal function in the two groups during treatment. Results:(1) Hemodynamic changes: before and after each use of mannitol in group M:CI and SVI were significantly increased, with statistical significance(P<0.01);SVRI showed a downward trend, and the changes after each use of mannitol were both There was statistical significance(P<0.01);PAWP and Lac increased at first and then decreased after operation, and the changes were statistically significant before and after mannitol use(P<0.05);RAP and MPAP had no statistical changes after the first use of mannitol However, the changes before and after the use of mannitol were statistically significant(P<0.05). Variance analysis of repeated measurement data was performed on the hemodynamic parameters of each group, and the results were all P<0.01.(2) Changes in urine volume: the urine volume in group M increased significantly after each use of mannitol, and the changes were statistically significant(P< 0.01);(3) The mechanical ventilation time and ICU stay time were statistically significant between the two groups(P < 0.05).(4) The two groups had no significant

关 键 词：体外循环 心脏术后 甘露醇 血流动力学 

分 类 号：R54[医药卫生—心血管疾病]