文章摘要
孙 杰,朱敬明,王灿琴,唐晓阳,丁正年.垂体后叶素对冠状动脉搭桥患者血流动力学的影响[J].南京医科大学学报,2009,29(1):106~109
垂体后叶素对冠状动脉搭桥患者血流动力学的影响
The effect of vasopressin on the hemodynamics in CABG patients
投稿时间:2008-10-10  
DOI:10.7655
中文关键词: 垂体后叶素  去甲肾上腺素  冠状动脉搭桥术  血流动力学
英文关键词: vasopressin  norepinephrine  CABG  hemodynamics
基金项目:
作者单位
孙 杰 南京医科大学附属第一医院麻醉科,江苏 南京 210029 
朱敬明  
王灿琴  
唐晓阳  
丁正年  
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中文摘要:
      目的:观察垂体后叶素在冠状动脉搭桥术(cardiac angioplastic bridge graft sugery,CABG)中对血流动力学的影响?方法: 20例行择期CABG的冠心病患者随机分为两组:去甲肾上腺素和垂体后叶素组?麻醉诱导后至手术结束,采用乳酸林格?人工胶体和红细胞悬液维持中心静脉压(CVP)和肺毛细血管楔压(PCWP)在8~10 cmH2O(0.785~0.981 kPa)左右,维持血球压积(HCT)不低于30%?分别使用去甲肾上腺素和垂体后叶素维持稳定的有创血压(IBP)?目标IBP 70 mmHg(1 mmHg = 0.133 kPa),心率(HR)60次/分?观察平均动脉压(MAP)?HR?ST-T?CVP?肺动脉压(PAP)?PCWP?外周血管阻力(SVR)?肺血管阻力(PVR)?心排量(CO)?尿量,间断监测动脉血气?手术时间?出血量?结果:两组患者MAP?HR?ST-T变化平稳;在搭后降支(PDA)时CVP?PCWP?SVR有所增加,心脏指数(CI)降低,但两组间无差异;PAP在搭PDA时升高,两组间有显著差异(P < 0.05)?垂体后叶素组PVR组内无差异,去甲肾上腺素组PVR在搭ADA和PDA时显著增加, 与同时间点去甲肾上腺素组的PVR相比较,组间有显著差异(P < 0.01)?倍他乐克使用量:垂体后叶素组使用量为5.9 mg,去甲肾上腺素组用量为11.2 mg,两组间有明显差异(P < 0.01)?结论:垂体后叶素较去甲肾上腺素更能很好地稳定冠状动脉搭桥患者术中的血流动力学状态?
英文摘要:
      Objective:To investigate the effect of vasopressin on the hemodynamics in cardiac angioplastic bridge graft sugery (CABG). Methods:Twenty coronary artery disease(CAD) patients were randomly divided into two groups:norepinephrine group and vasopressin group. During the anesthesia and the operation, the central venous pressure and pulmonary capillary wedge pressure were maintained to 8~10 cmH2O, and the hemocrit was maintained above 30% through lactate ringer’s mixture, artifact colloid and red blood cells. The invasive artery blood pressure(IBP) was maintained by appropriate anesthetic depth and norepinephrine or vasopressin respectively. The target IBP was 70 mmHg, and heart rate(HR) was 60 bpm. The MAP,HR,ST-T,CVP,PAP,PCWP,SVR,PVR,CO, urine output, blood gas analysis, surgery duration and blood loss were monitored. Results:The MAP,HR,and ST-T was stable in either group during the operation. CVP, PCWP and SVR increased but CI deceased during the posterior descending artery (PDA) was grafted in both groups and without any significant difference between them. PAP increased during PDA was grafted in either group and there was significant difference between the two groups. PVR increased during ADA and PDA were grafted in norepinephrine group but not in vasopressin group. Betaloc usage was 11.2 mg and 5.9 mg in norepinephrine group and vasopressin group respectively. Conclusion:Vasopressin can stabilize the hemodynics in CABG surgery better than norepinephrine.
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