尼卡地平对非心肺转流冠状动脉旁路移植术患者术中血流动力学和氧代谢的影响

发布时间：2018-11-01 20:18

【摘要】：目的探讨尼卡地平对非心肺转流冠状动脉搭桥术(off-pump coronary artery bypass grafting,OPCABG)患者术中血流动力学和氧代谢的影响。方法选择拟行OPCABG患者79例,年龄51~68岁,ASAⅢ或Ⅳ级,随机分为两组,近端血管吻合前分别持续泵注尼卡地平0.5μg·kg-1·h-1组(N组,n=41)或硝酸甘油0.5μg·kg-1·h-1组(G组,n=38)。记录麻醉前(T0)和用药后10min(T1)、30min(T2)、60 min(T3)、90 min(T4)时的氧代谢、血流动力学等指标变化情况,包括SvO2、MAP、PaO2、CO、HR和肺血管阻力(PVR)、体循环血管阻力(SVR)、CI、氧摄取率(ERO2)、乳酸(Lac)等。结果与T0时比较,T3,T4时两组患者氧耗明显降低,Lac浓度明显升高,且N组均明显低于G组(P0.05);T3,T4时G组PaO2、氧供明显降低,ERO2明显升高,N组PaO2、氧供明显高于,ERO2明显低于G组(P0.05)。与T0时比较,两组T1~T3时PAP、T1~T4时PVR和SVR均明显降低,T3,T4时CI明显升高(P0.05),且T1~T4时N组PVR和SVR明显低于G组,T4时CI明显高于G组(P0.05)。两组患者均顺利完成手术,术后均无严重并发症发生。结论尼卡地平可有效改善OPCABG患者术中氧代谢并维持血流动力学稳定。
[Abstract]:Objective to investigate the effect of nicardipine on hemodynamics and oxygen metabolism in patients with non-cardiopulmonary bypass coronary artery bypass (off-pump coronary artery bypass grafting,OPCABG). Methods Seventy-nine patients with OPCABG, aged 51 to 68 years, were randomly divided into two groups: group N received continuous infusion of nicardipine 0.5 渭 g kg-1 h-1 before proximal vessel anastomosis (group N). Either nitroglycerin 0. 5 渭 g kg-1 h-1 group (G group, n = 38), or nitroglycerin 0. 5 渭 g kg-1 h-1 group. The changes of oxygen metabolism and hemodynamics of 10min (T1), 30min (T2), 60 min (T3), 90 min (T4) before and after anesthesia were recorded, including SvO2,MAP,PaO2,CO,HR and pulmonary vascular resistance (PVR),. Systemic vascular resistance (SVR), CI, oxygen uptake rate (ERO2), lactate (Lac), etc. Results compared with T0, the oxygen consumption and Lac concentration in T3 / T4 group were significantly lower than those in G group (P0.05). At T _ 3 T _ 4, PaO2, oxygen supply decreased and ERO2 increased significantly in G group, PaO2, oxygen supply in N group was higher than that in G group, and ERO2 was significantly lower than that in G group (P0.05). Compared with T0, PVR and SVR in PAP,T1~T4 and CI in T3 / T4 were significantly decreased in both groups (P0.05), and PVR and SVR in T1~T4 group were significantly lower than those in G group, and CI in T4 group was significantly higher than that in G group (P0.05). The operation was successfully completed in both groups, and no serious complications occurred after operation. Conclusion nicardipine can effectively improve oxygen metabolism and maintain hemodynamic stability in patients with OPCABG.
【作者单位】：天津市胸科医院麻醉科;
【基金】：天津市卫生局科技基金(编号:12KG125)
【分类号】：R614

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