尼卡地平对体外循环患者胃肠灌注的影响

发布时间：2018-05-30 17:28

  本文选题：尼卡地平 + 体外循环　； 参考：《实用医学杂志》2015年20期

【摘要】：目的:通过监测尼卡地平对体外循环心脏手术患者胃黏膜血流变化、全身血流动力学指标、氧合指数的变化,探讨其对患者胃肠灌注的影响。方法:选取2014年1-12月在本院心脏外科行冠脉旁路移植加瓣膜置换的患者42例,按随机数字法分为尼卡地平组(N组)和对照组(C组),每组21例。两组患者行常规诱导麻醉后行右颈静脉穿刺,并插入Swan-Ganz导管,经胃镜引导下置入胃张力计,24 h连续监测患者胃部二氧化碳分压(Pg CO2)。对照组术中行常规静脉麻醉及体外循环方法 ;观察组患者麻醉诱导后以0.5μg/(kg·min)的速度持续泵入尼卡地平,术中维持平均动脉压(MAP)≥70 mm Hg。持续监测患者术中血流动力学指标。分别于患者体外循环前(T1)、开始转机后30 min(T2)、停机后30 min(T3)以及手术结束时(T4)测定患者静脉血氧饱和度(Sv O2),抽取动脉血测定血气分析计算氧供(DO2),氧耗(VO2),计算胃黏膜内动脉血CO2分压差(Pg-a CO2)。结果 :血流动力学:两组患者T3、T4时点心脏指数(CI)均高于T1(P0.05)。N组患者T3、T4时点CI显著高于对照组(P0.05);N组在T2、T3、T4时点SVRI(全身血管阻力指数)显著低于T1(P0.05),且N组T3、T4时点SVRI低于C组(P0.05)。氧合指数:两组患者Sv O2在T2时较T1显著升高,而C组在T3、T4时较T1显著下降,在T4时点N组显著高于C组(P0.05)。在T3、T4时点C组DO2,VO2与基础值相比变化不明显,而N组DO2显著高于基础值(P0.05)。C组在T3、T4时点Pg CO2与Pg-a CO2较T1显著升高,且显著高于N组(P0.05)。结论:尼卡地平能有效改善心脏血管术患者体外循环中氧合障碍、胃肠组织低灌注,减少对胃肠黏膜低血流灌注的损伤。
[Abstract]:Aim: to investigate the effects of nicardipine on gastrointestinal perfusion in patients undergoing cardiopulmonary bypass (CPB) by monitoring the changes of gastric mucosal blood flow, systemic hemodynamics and oxygenation index. Methods: Forty-two patients undergoing coronary artery bypass grafting and valve replacement in our hospital from January to December 2014 were randomly divided into nicardipine group (n = 21) and control group (n = 21). Right jugular vein puncture was performed after routine induction anesthesia in both groups, and Swan-Ganz catheter was inserted. Gastric tensor was placed under gastroscopy for 24 hours to continuously monitor the partial pressure of carbon dioxide in the stomach of the patients. In the control group, intravenous anesthesia and cardiopulmonary bypass were performed during the operation, and the patients in the observation group were continuously pumped into nicardipine at a speed of 0.5 渭 g/(kg after anesthesia induction, and the mean arterial pressure (MAPP) during the operation was 鈮，

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