尼卡地平对冠状动脉旁路移植术患者脑血流和功能的影响  

Effects of nicardipine on cerebral blood flow and function in patients undergoing coronary artery bypass grafting

作　　者：韩瑛 赵雅梅[1] 魏海燕[1] 苏中宏[1] 尹加林[1] 葛亚力[1] 史宏伟[1] HAN Ying;ZHAO Yamei;WEI Haiyan;SU Zhonghong;YIN Jialin;GE Yali;SHI Hongwei(Department of Anesthesiology,Perioperative and Pain Medicine,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉疼痛与围术期医学科,210006 [2]无锡市儿童医院麻醉科

出　　处：《临床麻醉学杂志》2023年第8期816-820,共5页Journal of Clinical Anesthesiology

摘　　要：目的探讨冠状动脉旁路移植术(CABG)患者在心肺转流(CPB)期间输注小剂量尼卡地平对脑血流和功能的影响。方法选择CPB下CABG患者64例,男41例,女23例,年龄60~79岁,BMI 18~29 kg/m^(2),ASAⅡ或Ⅲ级,NYHA分级Ⅱ或Ⅲ级,左室射血分数≥50%。采用随机双盲数字表法将患者分为两组:尼卡地平组(N组)和生理盐水组(C组),每组32例。N组在CPB开始后输注尼卡地平0.2~0.5μg·kg-1·min^(-1),于CPB停机后停止输注。C组于相同时点输注同等容量生理盐水。记录麻醉诱导前(T_(0))、外科切皮时(T_(1))、CPB 30 min(T_(2))、60 min(T 3)、停CPB 30 min(T_(4))、60 min(T 5)的动脉血气、心输出量(CO)、颈内动脉血流量(Q-ICA)、颈内动脉直径(D-ICA)和局部脑氧饱和度(rScO_(2))。记录术中去氧肾上腺素用量、术后拔管时间、ICU停留时间和术后住院时间。结果与C组比较,T_(2)—T 5时N组Q-ICA和D-ICA明显增加,rScO_(2)明显升高(P<0.05)。两组T_(0)—T 5时动脉血气指标、T_(0)、T_(1)时Q-ICA、D-ICA和rScO_(2)、术中去氧肾上腺素用量、术后拔管时间、ICU停留时间和术后住院时间差异均无统计学意义。结论在CABG患者CPB期间输注小剂量尼卡地平可以增加颈内动脉血流量,升高rScO_(2),减轻围术期神经功能损伤。Objective To investigate the effects of low-dose nicardipine infusion on cerebral blood flow and function in patients undergoing coronary artery bypass grafting(CABG).Methods Sixty-four patients with CABG under CPB were selected,41 males and 23 females,aged 60-79 years,BMI 18-29 kg/m^(2),ASA physical statusⅡorⅢ,NYHAⅡorⅢ,left ventricular ejection fraction≥50%.The patients were divided into two groups using a randomized double-blind number table method:nicardipine group(group N)and saline group(group C),32 patients in each group.Group N was infused with nicardipine 0.2-0.5μg·kg-1·min^(-1)after the start of CPB,and the infusion was stopped after the CPB stopped.Group C was infused with the same volume of normal saline at the same time point.The arterial blood gases,cardiac output(CO),quantity of flow of the internal carotid artery(Q-ICA),diameter of the internal carotid artery(D-ICA),and local cerebral oxygen saturation(rScO_(2))were recorded before anesthesia induction(T_(0)),during surgical skin resection(T_(1)),30 minutes after CPB started(T_(2)),60 minutes after CPB started(T 3),30 minutes after CPB stopped(T_(4)),60 minutes after CPB stopped(T 5).Intraoperative phenylephrine dose,postoperative extubation time,the length of ICU and postoperative hospital stay were recorded.Results Compared with group C,Q-ICA and D-ICA of group N were significantly increased at T_(2)-T 5,and rScO_(2)was significantly increased(P<0.05).There were no significant differences in arterial blood gas indexes at T_(0)-T 5,Q-ICA,D-ICA and rScO_(2)at T_(0)and T_(1),intraoperative dosage of norepinephrine,postoperative extubation time,ICU stay and postoperative hospital stay between the two groups.Conclusion During CPB in CABG patients,low-dose nicardipine infusion can increase internal carotid blood flow and rScO_(2),and reduce perioperative nerve function impairment.

关 键 词：冠状动脉旁路移植术 心肺转流 颈内动脉血流 局部脑氧饱和度 

分 类 号：R614[医药卫生—麻醉学]