摘要
目的观察风湿性心脏病病人瓣膜置换术中应用米力农对心肌的保护作用。方法20例风湿性心脏病瓣膜置换术病人,随机分为2组,每组10例。麻醉诱导开始前,米力农组给予米力农30μg·kg-1负荷量,继以0.5μg·kg-1·min-1持续静脉输注至术后24h;对照组用同样速度输注等量氯化钠注射液。于米力农负荷量剂量前(T0)、负荷量剂量后5min(T1)、开放主动脉1h(T2)、术后4h(T3)、术后24h(T4)抽血检测血浆白细胞介素6(IL-6)、白细胞介素8(IL-8)、心肌肌钙蛋白Ⅰ(cTnⅠ)水平,并记录血流动力学指标。结果与T0比较,2组T2～T4各时点IL-6、IL-8、cTnI均升高(P<0.05),但米力农组升高幅度低于对照组(P<0.05)。应用负荷剂量米力农后,米力农组T1～T4各时点心脏指数(CI)、每搏容量指数(SVI)和左室每搏作功指数(LVSWI)明显高于T0,肺毛细血管楔压(PCWP)和体循环阻力(SVR)明显低于T0(P<0.05),对照组变化不明显,2组差异显著(P<0.05)。结论体外循环下行心脏瓣膜置换术时使用米力农能够减少炎性因子产生,对心肌有保护作用。
AIM To evaluate the protective effect of milrinone on myocardium in patients with rheumatic heart disease undergoing cardiac valve replacement. METHODS Twenty adult rheumatic valve replacement patients were randomly divided into two groups： patients in milrinon group （n = 10） were given milrinone in an individual dose of 30 μg·kg^-1 before induction anesthesia and followed by a continuous infusion of 0.5 μg·kg^-1· min^-1 to 24 hours postoperatively; the patients in control group （n = 10） were given the same volume of sodium chloride injection. Blood samples were taken before loading dose of milrinone （To）, 5 minutes after loading dose of milrinone （T1）, 1 hour after aortic release （T2）, 4 hours postoperatively （T3） and 24 hours postoperatively （T4） to determine plasma IL-6, IL-8, and cTnI. The parameters of hemodynamics were obtained before and after loading dose of milrinone and at other time points. RESULTS In both groups, IL-6, IL-8, and cTnI values increased significantly from T2 to T4 as compared with the baseline values （P 〈 0.05）, but were lower in the milrinon group than those in the control group （P 〈 0.05） . After loading dose of milrinone, CI, SVI, and LVSWI from T1 to T4 were significantly higher than that of To in the milrinon group, while SVR and PCWP were significantly lower than To （P 〈 0.05） . No significant changes revealed in the control group, showed significant difference in these parameters between the two groups （P 〈 0.05） . CONCLUSION Milrinone can inhibit cardiopulmonary bypass-induced systemic proinflammatory response and provide the protective effect on myocardium during cardiac valve replacement.
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2009年第7期537-540,共4页
Chinese Journal of New Drugs and Clinical Remedies
关键词
米力农
风湿性心脏病
强心药
瓣膜置换术
milrinone
rheumatic heart diseases
cardiotonic agents
valve replacement
