艾司洛尔对停跳心脏瓣膜置换患者围术期血清cTn-Ⅰ的影响

发布时间：2018-02-02 21:21

本文关键词： 艾司洛尔体外循环心脏瓣膜置换术心肌肌钙蛋白Ⅰ　出处：《广西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的观察体外循环(CPB)期间应用艾司洛尔,对停跳心脏瓣膜置换患者围术期血清心肌肌钙蛋白I (cTn-I)的变化影响,探讨其应用是否能减轻心肌损伤,有利于术后心功能的恢复。方法在我院符合研究条件、年龄18～70岁择期行体外循环心脏停跳下行心脏瓣膜置换手术患者中,按数字随机法选择48例患者,再随机分为两组,每组各24例,实验组为A组(艾司洛尔),对照组为C组。A组患者在体外循环开始时及主动脉开放前1分钟,分别经体外循环膜肺给药管路给予艾司洛尔注射液2mg/kg, C组在体外循环开始时及主动脉开放前1分钟,分别经体外循环膜肺给药管路给予等容量的生理盐水。在体外循环开始前(T1)、术后1h (T2)、24h (T3)和48h(T4),经静脉采血检测血清心肌肌钙蛋白I (cTn-I)的数值；记录患者主动脉阻断时间、转机时间、手术时间、术后呼吸机支持时间、CCU的住院时间、术后住院时间；观察记录患者升主动脉开放后心脏复跳情况；术毕时正性肌力药物使用情况。应用SPSS 16.0软件行统计分析,计量资料以x±s表示,两样本均数检验用t检验,多个样本均数检验用重复测量方差分析,两计数资料比较用χ2检验,以α=0.05检测水平,p0.05为有统计学差异。结果两组患者年龄、性别、术前心功能分级、术式等无统计学差异；两组患者的主动脉阻断时间、转机时间、手术时间、术后呼吸机支持时间、术后CCU的住院时间、术后住院时间无统计学差异。A组中自动复跳23例(23/24,95.8%),高于C组16例(16/24,67%) (X2=24,p=0.042)。术毕时,多巴胺注射速度A组：4.71±1.30μg/kg/min,C组：4.46±1.0μg/kg/min(P0.05)。A组合用肾上腺素的例数为3/24(12.5%)少于C组12/24(500,6) (χ2=15.73,P=0.000)；A组术毕肾上腺素注射速度为0.005±0.013μg/kg//min,低于C组0.014±0.016μg/kg/min(t=2.42,P0.05)；在术后1h(T2).24h(T3)和48h(T4),两组患者的血清cTn-I值均较T1明显升高,其中在T3达最高值。但在术后24h(T3),A组的血清cTn-I值为10.93±4.50μg/L,低于C组的血清cTn-I值19.07±5.06pg/L(t=5.89,P0.05):在术后48h(T4),A组的血清cTn-I值为9.06±3.87μg/L,也低于C组的血清cTn-I值15.97±4.43μg/L(t=5.75,P0.05).结论停跳心脏瓣膜置换术患者CPB开始及升主动脉开放前1分钟,给予艾司洛尔2mg/kg的剂量,提高心脏的自动复跳率,可减轻心肌损伤,对术后心功能的恢复有积极作用。
[Abstract]:Objective to observe the effect of esmolol on serum cardiac troponin I (cTn-I) in patients undergoing cardiac valve replacement during cardiopulmonary bypass (CPB). To explore whether the application can alleviate myocardial injury and facilitate the recovery of cardiac function after operation. 48 patients (1870 years old) undergoing cardiac valve replacement under cardiopulmonary bypass (CPB) were randomly divided into two groups (24 cases in each group). Group A (group A), group C (group C) and group A (group C) at the beginning of cardiopulmonary bypass (CPB) and one minute before aortic opening. Two mg / kg esmolol injection was given through the pulmonary tube of cardiopulmonary bypass respectively. Group C was given at the beginning of cardiopulmonary bypass and one minute before the aorta was opened. Normal saline was given to the lung through the membrane of cardiopulmonary bypass (CPB). Before CPB, T1 was given before CPB, and T3 at 1h after CPB and T3 at 48h after CPB. The serum cardiac troponin I (cTn-I) was measured by intravenous blood sampling. The time of aortic clamping, transit time, operation time, postoperative ventilator support time and hospitalization time of CCU were recorded. The cardiac resuscitation was recorded after the ascending aorta was opened. SPSS 16.0 software was used to do statistical analysis. The metrological data were expressed as x 卤s, and the mean of two samples was tested by t test. Multiple sample mean test was performed by repeated analysis of variance, 蠂 2 test was used to compare the two counting data, and there was significant difference between the two groups in terms of 伪 -0.05 level (p 0.05). Results the age and sex of the two groups were significantly higher than those of the control group. There was no significant difference in preoperative cardiac function grading and operative methods. The aortic clamping time, transit time, operation time, postoperative ventilator support time, postoperative CCU hospitalization time of the two groups. There was no significant difference in postoperative hospital stay. In group A, 23 cases of spontaneous resuscitation were 23 / 2495.8, which was higher than that of group C (16 / 16 / 24 / 67). At the end of the operation, the dopamine injection rate in group A was 4.71 卤1.30 渭 g / kg / min. Group C: 4.46 卤1.0 渭 g / kg / kg P0.05A was less than group C in the number of cases of epinephrine (3 / 24 / 12.5a) than in group C (12 / 24 / 24 / 500). (6) (蠂 2 = 15.73) (P = 0.000); The injection rate of epinephrine in group A was 0.005 卤0.013 渭 g / kg / min after operation, which was lower than that in group C (0.014 卤0.016 渭 g / kg / kg / min). P0.05; The serum cTn-I levels in both groups were significantly higher than those in T1 at 1 h after operation, and at 24 h after operation, and reached the highest at T3, but at 24 h after operation, the serum cTn-I levels in both groups were significantly higher than those in T1, but at 24 h after operation, the serum cTn-I levels in both groups were significantly higher than those in T1. The serum cTn-I of group A was 10.93 卤4.50 渭 g / L, which was lower than that of group C (19.07 卤5.06pg / L). P0.05: the serum cTn-I of group A was 9.06 卤3.87 渭 g / L at 48h after operation. The serum cTn-I of group C was also lower than that of group C (15.97 卤4.43 渭 g / L). Conclusion in patients with cardiac valve replacement due to cardioplegia, 2 mg / kg of esmolol was given at the dose of 2 mg / kg at the beginning of CPB and 1 minute before the opening of ascending aorta, so as to increase the rate of automatic cardiac resuscitation. It can reduce myocardial injury and has a positive effect on the recovery of cardiac function after operation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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