瓣膜手术中氨力农对血液动力学指标的影响观察  

Hemodynamic efficaey of amrinone therapy in patients undergoing cardiac valve replacement

作　　者：于灵芝[1] 刘志文[2] 刘平[2] 

机构地区：[1]山东大学临床医学院济南市中心医院麻醉科,济南市250013 [2]山东省立医院麻醉科

出　　处：《临床麻醉学杂志》2004年第3期138-140,共3页Journal of Clinical Anesthesiology

摘　　要：目的　探讨心脏瓣膜手术中氨力农对血液动力学的影响及其临床应用价值。方法　择期心内直视瓣膜置换手术病人 79例。术前用药为东莨菪碱、吗啡。麻醉以咪唑安定、芬太尼、维库溴铵和丙泊酚维持 ,并间断吸入异氟醚或七氟醚。桡动脉穿刺置管行直接动脉压监测。诱导后经颈内静脉穿刺置入中心静脉导管和SWAN GANZ导管 ,分别测定中心静脉压 (CVP)、肺动脉楔压(PCWP)、肺动脉压 (MPAP)、心输出量 (CO) ,并同时相抽取动脉血和混合静脉血行血气分析 ,计算体循环阻力 (SVR)、肺循环阻力 (PVR)和心脏指数 (CI)。A组于停机前 10～ 15min经心肺转流 (CPB)单次给予氨力农 1 0～ 1 3mg/kg ,然后以 5～ 8μg·kg 1·min 1持续静脉输入。N组不用氨力农 ,两组均根据停机后的心功能及循环状态酌情使用循环支持药 儿茶酚胺类药 (多巴胺、多巴酚丁胺、去甲肾上腺素 ) ,维持CI在 3 0L·min 1·m 2 以上。所有指标对照分析时机为诱导后开胸前循环稳定时(S0 )、停机后即刻 (S1)、停机后 1h(S2 )、手术结束前 (S3 )。结果　CPB前各项指标均无显著性差异。CPB后两组间HR、CVP、MPAP、CI无显著性差异 ;SVR于S1、S2 、S3 各时点A组显著降低 ,并明显低于N组 (P <0 0 1) ;PVR两组间的差异不如SVR明显 ,但于S2 时点A组显著低于N组。Objective To observe the hemodynamic effects of amrinone on patients undergoing cardiac valve replacement surgeries.Methods seventy-nine patients were randomly assigned into amrinone(A) group and non-amrinone(N)group.Patients were premedicated with scopolamine and morphine.Anesthesia was inducted with midazolam,fentanyl and vecuronium.Propofol was continuously infused intravenously.Isoflurane or sevoflurane was inhaled when needed.Invasive blood pressure and central venous pressure (CVP)were monitored.So were the pulmonary capillary wedge pressure (PCWP),mean pulmonary artery pressure (MAP) and cardiac output (CO).Arterial blood gas analysis and mixed venous blood gas analysis were simultaneously carried out.Systemic vascular resistance(SVR),pulmonary vascular resistance (PVR)and cardiac index(CI)were calculated.Patients in group A were loaded with amrinone 1.0-1.3 mg/kg ten to fifteen minutes prior to wean from cardiopulmonary bypass(CPB),and followed by 5-8μg·kg -1·min -1 dripping.No amrinone was given in group N.Circulatory supporting medicines such as dopamine,dobutamine,nonadrenaline,etc.were administered to keep the heart and circulatory function stable,so that the CI would not drop lower than 3.0L·min -1·m -2.All the parameters were analyzed before chest opening (S 0),right after CPB(S 1),one hour after CPB off (S 2),at the end of operation(S 3).Results Before CPB the parameters showed no significant difference between the two groups.SVR in group A decreased at the points of S 1,S 2 and S 3,and also significantly lower than that in group N(P<0.01).The change of PVR was not as markedly as that of SVR,which in group A was lower than that in group N at S 2(P<0.05).In group A,none of patients needed nonadrenaline treatment,and 41 patients received dobutamine.In group N however,43 patients received nonadrenaline treatment.The amount of both dopamine and dobutamine needed was larger in group N than in group A (P<0.01).Conclusion With the help of amrinone treatment,the need of cat

关 键 词：瓣膜手术 氨力农 血液动力学指标 心脏瓣膜置换 

分 类 号：R654.2[医药卫生—外科学]