不同血管活性药物对体外循环下成人先天性心脏病矫治术患者术后乳酸值的影响  

Effects of different vasoactive drugs on lactic acid level in adults undergoing corrective surgery for congenital heart disease under extracorporeal circulation

作　　者：钱晓亮[1] 陈月 姚翔燕 豆立冬 Qian Xiaoliang;Chen Yue;Yao Xiangyan;Dou Lidong(Department of Extracorporeal Circulation,Heart Center of Henan Provincial People's Hospital,Huazhong Fuwai Hospital,Zhengzhou 451464,Henan,China;Department of Anesthesiology,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,Henan,China)

机构地区：[1]河南省人民医院心脏中心,华中阜外医院体外循环科,河南郑州451464 [2]河南省人民医院麻醉与围术期医学科,郑州大学人民医院,河南郑州450003

出　　处：《实用检验医师杂志》2024年第4期319-323,共5页Chinese Journal of Clinical Pathologist

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20230127)。

摘　　要：目的评价不同血管活性药物对体外循环下成人先天性心脏病矫治术患者术后乳酸值的影响。方法选择2020年1月—2022年12月在华中阜外医院进行体外循环下成人先天性心脏病矫治术的40例患者作为研究对象,根据术后用药方案不同分为肾上腺素组和多巴胺组,每组各20例。体外循环复温后肾上腺素组静脉输注肾上腺素注射液0.03 μg·kg^(-1)·min^(-1),多巴胺组静脉输注多巴胺注射液0.05 μg·kg^(-1)·min^(-1),维持药量直至手术结束患者安返监护室。比较两组主动脉阻断时间、体外循环时间、麻醉时间、术后拔管时间,以及不同时间点〔体外循环转机前(T1)、转机30 min(T2)、复温(T3)、开放升主动脉(T4)、停止体外循环10 min(T5)、停止体外循环60 min(T6)、术后1 h(T7)、术后3 h(T8)、术后6 h(T9)、术后9 h(T10)〕两组患者的血气分析指标及血浆乳酸值水平差异。结果肾上腺素组和多巴胺组的主动脉阻断时间、体外循环时间、麻醉时间、术后拔管时间差异均无统计学意义〔主动脉阻断时间(min):35.2±12.3比39.6±15.9;体外循环时间(min):67.5±23.4比69.3±16.3;麻醉时间(h):3.2±0.8比3.5±0.3;术后拔管时间(h):6.5±0.6比6.2±0.9;均P>0.05〕。肾上腺素组T5、T6、T7、T8、T9时间点的血浆乳酸值均显著高于多巴胺组,差异均有统计学意义〔T5(mmol/L):2.7±0.6比1.7±0.7;T6(mmol/L):3.0±0.4比1.8±0.8;T7(mmol/L):3.5±0.6比2.0±0.4;T8(mmol/L):5.3±0.6比1.7±0.4;T9(mmol/L):3.5±0.4比1.4±0.2;均P<0.05〕。结论肾上腺素作为体外循环下心脏手术后的血管活性辅助用药较多巴胺更易引起血浆乳酸值的升高,但并不影响患者的预后转归。Objective To evaluate the effects of different vasoactive drugs on lactic acid level in adults undergoing corrective surgery for congenital heart disease under extracorporeal circulation.Methods Forty patients who underwent corrective surgery for congenital heart disease under extracorporeal circulation at Huazhong Fuwai Hospital from January 2020 to December 2022 were selected as study subjects.According to different postoperative medication regimens,the patients were divided into adrenaline group and dopamine group,with 20 cases in each group.After extracorporeal circulation and rewarming,the patients in adrenal group received intravenous infusion of adrenaline injection at a dose of 0.03μg·kg^(-1)·min^(-1),while the patients in dopamine group received intravenous infusion of dopamine injection at a dose of 0.05μg·kg^(-1)·min^(-1).The dosage was maintained until the end of the surgery and safe return to monitoring room.The arterial occlusion time,extracorporeal circulation time,anesthesia time,postoperative extubation time,as well as blood gas analysis indicators and plasma lactic acid levels of two groups at different time points[before extracorporeal circulation transfer(T1),30 minutes after transfer(T2),rewarming(T3),opening ascending aorta(T4),stopping extracorporeal circulation for 10 minutes(T5),stopping extracorporeal circulation for 60 minutes(T6),1 hour after surgery(T7),3 hours after surgery(T8),6 hours after surgery(T9)and 9 hours after surgery(T10)]were compared.Results There were no statistically significant differences in arterial occlusion time,extracorporeal circulation time,anesthesia time and postoperative extubation time between adrenaline group and dopamine group[arterial occlusion time(minutes):35.2±12.3 vs.39.6±15.9;extracorporeal circulation time(minutes):67.5±23.4 vs.69.3±16.3;anesthesia time(hours):3.2±0.8 vs.3.5±0.3;postoperative extubation time(hours):6.5±0.6 vs.6.2±0.9;all P>0.05].The plasma lactic acid levels at time points T5,T6,T7,T8 and T9 in adrenaline group were h

关 键 词：心脏手术 体外循环 血管活性药物 多巴胺 肾上腺素 血浆乳酸值 

分 类 号：R65[医药卫生—外科学]