小剂量甘露醇缓慢静脉滴注对体外循环下心脏术后患者血流动力学的影响  

Effects of slow intravenous infusion of low-dose mannitol on hemodynamics in patients after cardiac surgery under cardiopulmonary bypass

作　　者：郭浩[1] 何亚梅[2] 李温斌[3] 邢学勇 李娜[1] 袁帅飞[1] 冯旭 崔星斌 Guo Hao;He Yamei;Li Wenbin;Xing Xueyong;Li Na;Yuan Shuaifei;Feng Xu;Cui Xingbin(Department of Critical Care Medicine,Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453000,China;Department of Surgery,Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453000,China;Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]新乡医学院第三附属医院重症医学科,新乡453000 [2]新乡医学院第三附属医院手术部,新乡453000 [3]首都医科大学附属北京安贞医院心脏外科中心,北京100029

出　　处：《中华胸心血管外科杂志》2022年第9期554-558,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：河南省医学科技攻关计划 (LHGJ20190488)。

摘　　要：目的探讨小剂量甘露醇缓慢静脉滴注对体外循环心脏术后患者血流动力学的影响。方法前瞻性连续纳入2020年6月至2022年3月期间在新乡医学院第三附属医院行体外循环下心脏外科手术的患者62例,其中男37例,女25例;年龄35~74岁,平均(59.95±9.35)岁。随机数字表法分为常规治疗组(C组)29例和甘露醇治疗组(M组)33例。C组术后按常规治疗;M组在常规治疗的基础上,分别于术后1、8、24 h静脉滴注20%甘露醇注射液0.25 g/kg,每次滴注60 min。记录两组各时点血流动力学指标,包括心脏指数(CI)、右心房压(RAP)、肺动脉楔压(PAWP)、平均肺动脉压(MPAP)、每博指数(SVI)和体循环阻力指数(SVRI)。结果每次使用甘露醇后,M组患者的CI、SVI值均比使用前显著升高,差异有统计学意义(P<0.01);SVRI值呈下降趋势,且每次使用甘露醇前后差异有统计学意义(P<0.01);术后PAWP先升高后降低,使用甘露醇前后差异有统计学意义(P<0.05)。首次使用甘露醇前后RAP、MPAP值差异无统计学意义,但后两次使用前后差异有统计学意义(P<0.05)。重复测量各组血流动力学参数,所得数据行方差分析结果均显示P<0.01。结论术后小剂量甘露醇缓慢静脉滴注有助于优化血流动力学状态,提高每搏输出量,降低心脏前负荷,改善体循环、肺循环阻力,促进术后心肺功能恢复。Objective To investigate the effect of slow intravenous infusion of low-dose mannitol on the hemodynamics of patients after cardiopulmonary bypass.Methods Prospective,continuous inclusion of 62 patients after cardiac surgery under cardiopulmonary bypass.By random number method,they were divided into normal treatment group(group C)with 29 cases and mannitol treatment group(group M)with 33 cases.Group C was treated according to the postoperative routine treatment measures.On the basis of conventional treatment,group M received intravenous infusion of 20%mannitol injection 0.25 g/kg at 1、8、24 hours after operation,and the intravenous infusion time was 60 minutes each time.According to the hemodynamic changes during the two groups of treatment,the effect of slow intravenous infusion of low-dose mannitol on patients after cardiopulmonary bypass under cardiopulmonary bypass was analyzed.Results In group M,CI and SVI were significantly increased after use of mannitol than before,with statistical significance(P<0.01).SVRI showed a downward trend,and the changes were statistically significant after use of mannitol(P<0.01).PAWP increased first and then decreased after operation,and the changes were statistically significant after mannitol use than before(P<0.05).RAP and MPAP had no significant changes after the first use of mannitol,but the changes after the latter two use mannitol were statistically significant than before(P<0.05).Repeated-measurement data analysis of variance was performed on the hemodynamic parameters of each group,and the results were all P<0.01.Conclusion Postoperative slow intravenous infusion of low-dose mannitol optimizes hemodynamic status,increases stroke volume,reduces cardiac preload,improves systemic and pulmonary circulation resistance,and promotes recovery of postoperative cardiopulmonary function.

关 键 词：体外循环 心脏外科术后 甘露醇 血流动力学 

分 类 号：R654.2[医药卫生—外科学]