文章摘要
胡小菊,史宏伟,严金燕,赵雅梅,葛亚力,魏海燕.二尖瓣置换术患者体外循环后早期是否需要应用多巴胺[J].南京医科大学学报,2013,(2):226~230
二尖瓣置换术患者体外循环后早期是否需要应用多巴胺
Is early dopamine therapy required for in patients undergoing mintral valve replacement after cardiac pulmonary bypass?
投稿时间:2012-08-09  
DOI:10.7655/NYDXBNS20130218
中文关键词: 多巴胺  体外循环  二尖瓣置换术  左心室  血流动力学
英文关键词: dopamine  cardiac pulmonary bypass  mitral valve replacement  left ventricular  hemodynamics
基金项目:南京市卫生青年人才培养工程
作者单位
胡小菊 南京医科大学附属南京医院麻醉科,江苏 南京 210006 
史宏伟 南京医科大学附属南京医院麻醉科,江苏 南京 210006 
严金燕 南京医科大学附属南京医院麻醉科,江苏 南京 210006 
赵雅梅 南京医科大学附属南京医院麻醉科,江苏 南京 210006 
葛亚力 南京医科大学附属南京医院麻醉科,江苏 南京 210006 
魏海燕 南京医科大学附属南京医院麻醉科,江苏 南京 210006 
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中文摘要:
      目的:观察多巴胺在二尖瓣置换术患者体外循环后早期对左心室收缩功能?血流动力学及尿量的影响,评价多巴胺对心内直视手术的临床效果。方法:选择18例择期于体外循环下行单纯二尖瓣置换的患者作为研究对象。按美国麻醉医师学会(ASA)分级为Ⅱ级或Ⅲ级,年龄≤70岁,男女不限,术前NYHA心功能分级为Ⅱ级或Ⅲ级,术前射血分数(EF)≥45%,且术前未使用正性肌力药物。麻醉诱导及术中维持均全凭静脉麻醉。将患者分为多巴胺组(D组,8例)和非多巴胺组(F组,10例)。D组:体外循环停机后,经静脉泵给予多巴胺;F组:体外循环停机后,未给予多巴胺。在起搏器控制心室率一致的情况下,比较两组患者体外循环后(泵注多巴胺后)心排血量指数(CI)?左室射血分数(LVEF)?中心静脉压(CVP)?平均动脉压(MAP)?全身血管阻力指数(SVRI)?乳酸?尿量及血管活性药物去氧肾上腺素使用量。结果:D组与F组组内比较差异无统计学意义(P > 0.05);组间比较,D组与F组相同时间点相比,除30?60 min时间点F组 LVEF高于D组外,CI?LVEF?CVP?MAP?SVRI及去氧肾上腺素使用量间比较差异无统计学意义(P > 0.05),但D组与F组尿量相比差异有统计学意义(P < 0.05),同时D组与F组相同时间点乳酸值相比差异有统计学意义(P < 0.01)。结论:对于体外循环后心功能正常患者,预防性使用多巴胺没有临床必要性,但能明显增加尿量和乳酸的清除。
英文摘要:
      Objective:To observe the early effects of dopamine on patients undergoing mitral valve replacement after cardiac pulmonary bypass on left ventricular contraction,hemodynamics and urine volume,so as to revaluate the clinical effects of dopamine on patients undergoing open heart operation. Methods:Eighteen patients with American Society of Anesthesiologists Status(ASA)Ⅱ~Ⅲ,age≤70 years,male or female,preoperatively NYHAⅡ~Ⅲ,EF≥45% and without using cardiotonic agents,scheduled for mitral valve replacement were studied. Complete intravenous general anesthesia was used in anesthesia induction and during intraoperative anesthesia. The patients were divided into two groups,including the D group(n = 8) and the F group(n = 10). The D group:after cardiac pulmonary bypass with continuous infusion dopamine intravenously; thr F group:without receiving dopamine intravenously. With controlling the coincidence of ventricular rate by pacemaker,cardiac index(CI),left ventricular ejection fraction(LVEF),central venous pressure(CVP),mean arterial pressure(MAP),systemic vascular resistance index(SVRI),the value of lactic acid,urine volume and phenylephrine dosage were compared between two groups after cardiac pulmonary bypass. Results:Within the group D and F,the values of the examinations had no statistical significance (P > 0.05). Except that the LVEF at the points 30 min and 60 min of the group F were more than the group D,there were no differences in the levels of CI,LVEF,CVP,MAP,SVRI,urine volume and phenylephrine dosage between the two groups at the same points(P > 0.05). However,the urine volume of the groups D and F had statistical significance(P < 0.05),and lactic acid value at the same points between both of the groups were significantly different (P < 0.01). Conclusion:In this study,the result suggested that it isn’t necessary for the normal heart function of the patients undergoing mitral valve replacement after cardiac pulmonary bypass to receive prophylactic dopamine,but obviously increasing urine output and the clearance of lactic acid.
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