围术期应用活血化瘀和艾司洛尔对高龄骨伤患者心肌保护的疗效观察

发布时间：2018-04-29 20:31

本文选题：活血化瘀 + 艾司洛尔　；参考：《四川中医》2016年12期

【摘要】：目的:观察围术期应用活血化瘀和艾司洛尔对高龄骨伤患者的心肌保护的疗效分析。方法:选择我院年龄≥60岁,临床已确诊的缺血性心肌病、冠心病的下肢骨折择期行手术治疗的患者120例,采用随机对照分为4组,分别为空白对照组(C组)、活血化瘀组(H组)、艾司洛尔组(β组)、活血化瘀+艾司洛尔组(Hβ组),每组30例。C组麻醉诱导给予安慰剂持续泵注直至手术结束,H组术前5天开始口服"七味三七口服液",手术当日停用,术后第2天开始服用直至术后10天。β组麻醉诱导后持续泵注艾司洛尔(1mg/kg/h)直至手术结束,Hβ组术前5天开始口服"七味三七口服液",手术当日停用,术后第2天开始服用直至术后10天。麻醉诱导后持续泵注艾司洛尔(1mg/kg/h)直至手术结束。每组患者在入院当天、术前1天,术后1天,术后10天检测缺血修饰白蛋白(IMA),在术中记录每组各时点(入室、给氧诱导、插管、手术开始、术中10分钟、20分钟、30分钟、手术结束、拔管)的ST段和心肌耗氧量(心肌耗氧量=收缩压×心率)的变化。结果:在组内比较H组、β组、Hβ组的IMA值在术后1天、10天与入院当天相比较明显降低,具有统计学意义(P0.05)。在组间比较组间比较H组、β组、Hβ组的IMA值在手术后1天、10天分别与C组比较明显降低,具有统计学意义(P0.05),H组和β组的IMA值之间比较无明显差异,但Hβ组在术后1天、10天分别与H组、β组比较IMA值有上升趋势,IMA值的异常率增高。术中各时点H组、β组、Hβ组的ST段值的异常率分别与C组比较具有统计学差意义(P0.05),但H组、β组、Hβ组三组分别比较无明显差异。术中各时点H组、β组、Hβ组的心肌耗氧量与C组比较有下降趋势,但这四组之间比较无统计学差异。结论:初步研究发现围术期应用活血化瘀和艾司洛尔对高龄骨伤患者可减少术中及术后早期心肌损伤发生率,可提高高龄骨伤患者心血管稳定性及高心肌耗氧量的耐受能力,从而起到心肌保护作用。但同时使用活血化瘀和艾司洛尔则降低相互之间的心肌保护作用疗效。
[Abstract]:Objective: to observe the effect of promoting blood circulation and removing blood stasis and esmolol on myocardial protection in elderly patients with bone injury. Methods: 120 patients with ischemic cardiomyopathy and coronary heart disease, aged more than 60 years, were selected and randomly divided into 4 groups. There were 30 cases in each group, 30 cases in group C, 30 cases in group C and 30 cases in group C received continuous infusion of placebo until the end of operation, 5 cases in group H before operation. The day began to take "Qiwei Sanqi Oral liquid", which was stopped on the day of operation. The patients in the 尾 group received continuous infusion of esmolol (1 mg / kg 路kg / h) after anesthesia induction until the end of the operation, 5 days before the operation and 5 days before the operation, the group took "Qiwei Sanqi Oral liquid", which was stopped on the day of operation. Take it on the second day of operation until 10 days after operation. After anesthesia induction, continuous infusion of esmolol 1 mg / kg / h until the end of the operation. The patients in each group were examined for IIA on admission day, 1 day before operation, 1 day after operation and 10 days after operation. Each group was recorded at each time point (room entry, oxygen induction, intubation, operation beginning, 10 minutes, 20 minutes, 30 minutes) during operation. Changes of St segment and myocardial oxygen consumption (myocardial oxygen consumption = systolic pressure 脳 heart rate) at the end of operation. Results: the IMA value of H 尾 group was significantly lower than that of H 尾 group on the 1st and 10th day after operation compared with the admission day, which was statistically significant (P 0.05). The IMA of H 尾 group was significantly lower than that of C group on the 1st and 10th day after operation. There was no significant difference in IMA between P 0.05 group and 尾 group. However, the abnormal rate of IMA in H 尾 group was higher than that in H group on the 1st and 10th day after operation. The abnormal rate of St segment in H group and 尾 group was significantly lower than that in group C (P 0.05), but there was no significant difference between H group and H 尾 group. The myocardial oxygen consumption of H group and 尾 group H 尾 decreased significantly compared with that of group C, but there was no significant difference among these four groups. Conclusion: the preliminary study found that the perioperative application of promoting blood circulation and removing blood stasis and esmolol can reduce the incidence of myocardial injury during and after operation in elderly patients, and can improve the cardiovascular stability and tolerance of high myocardial oxygen consumption in elderly patients with bone injury. Thus, it plays a protective role in myocardium. However, combined use of blood circulation and blood stasis and esmolol reduced the myocardial protective effect between each other.
【作者单位】：四川省骨科医院麻醉科;
【基金】：四川省骨科医院院内课题—菱形阻滞结合中医药治疗髌股关节病的临床疗效研究(编号:2015-27)
【分类号】：R687.3

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