摘要
目的探讨小剂量艾司洛尔(esmolol)对体外循环(CPB)心脏手术后心脏复苏的影响,并观察其对CPB前循环功能的影响。方法24例拟行心脏瓣膜置换术的患者,随机分为两组,每组12例。esmolol组(Esm组)于手术开始时静脉持续输注Esmolol 100μg/(kg·min)直至开放主动脉后1min,并于CPB机内预充esmolol 1mg/kg。对照组(Contr组)输入等容量的复方氯化钠液(Ringer's)。记录用药后15min内病人的血压、心率与中心静脉压;记录心脏复跳方式、停CPB后血压平稳时多巴胺的维持剂量,于术前、停CPB后血压平稳时抽中心静脉血测其血氧饱和度(ScvO2);于术前及复跳20min测血浆香草扁桃酸(VMA)浓度;于术前及术后12h测血浆磷酸肌酸激酶(CK)和磷酸肌酸激酶同功酶(CK-MB)浓度。结果用esmolol 15min内两组病人血压、心率、中心静脉压无明显区别;两组病人复跳20min后血浆VMA高于术前,但组间差异无显著性;两组病人术后12h血浆CK、CK-MB均高于术前(P<0.01),组间差异无显著性;两组病人复跳方式差异无显著性;停CPB后血压平稳时Esm组多巴胺的维持剂量小于Contr组(P<0.01),Esm组ScvO2高于Contr组(P<0.01)。结论心脏瓣膜置换术中持续输注艾司洛尔100μg/(kg·min)能改善心脏复苏的质量,且对CPB前循环功能无明显影响。
[Objective] To investigate the effect of Esmolol on cardiac resuscitation after cardiac valve replacement and to observe the effect of esmolol on circulatory function before cardiopulmonary bypass （CPB）. [Methods] Twenty-four cardiac function class Ⅱ-Ⅲ patients of either sex （14 male,10 female）, aged 16-55 years, left ventricular ejection fraction （LVEF）〉50%, undergoing cardiac valve replacement were randomly divided into two groups of 12 patients each ： esmolol group（Esm） and control group （Contr）. The patients had not received long-term treatment with Glucocorticoids, calcium channel blocker, β-adrenocepter agonist or antagonist, or angiotensin converting enzyme（ ACE ） inhibitior. Patients with bradycardia, atrioentricular （AC） block〉 Ⅱ degree, severe liver/kidney function abnormality, diabetes, hypertension, thyroid disease or blood diseases were also excluded. Anesthesia was induced with Midazolam 0.15 mg/kg, Fentanyl 10 ug/kg and Vecuronium 0.15 mg/kg and maintained with Midazolam and Fentanyl. In group ESM, Esmolol was continued infused at the rate of 100 ug/（kg·min） until lmin after aortic declamping. In group Contr, Ringer＇s solution was infused at the rate of 0.01 mL/（kg·min） instead of Esmolol. Radial artery and right internal jugular vein were cannulated and BP, HR were monitored during operation. The blood samples were taken before operation and warm up for determination of plasma vanillymandelic acid （VMA）. CVP blood was obtained for determination of plasma Creatine Kinase （CK） and Creatine Kinase iosenzyme （CK-MB） before operation and 12 h after operation, and was obtained for determination of central venous oxygen saturation （SevO2） when blood pressure was stable after CPB terminated. The method of heart-beat restore and the dosage of Dopamine were recorded when blood pressure was stable after CPB terminated. [Results] The method of heart-beat restore, the concentration of CK, CK-MB and VMA before operation and 12 h after operation （or warm up） has no significant difference before operation between two groups. The dosage of Dopamine was significantly lower in group Esm than what in group Contr, and the ScvO2 was significantly higher in group ESM than what in group Contr after CPB when blood pressure was stable （P 〈0.01）. The concentration of CK, CK-MB and VMA at 12 h after operation increased significantly campared with before operation in each group （P 〈0.01）. [Conclusion] Esmolol can improve cardiac resuscitation after cardiac valve replacement.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2007年第9期1094-1097,1100,共5页
China Journal of Modern Medicine
关键词
艾司洛尔
体外循环
心脏手术
心脏复苏
Esmolol
cardiopulmonary bypass
cardiac resuscitation
heart surgery
