本文選題：活血化瘀 + 艾司洛爾�。� 參考：《四川中醫(yī)》2016年12期

【摘要】：目的:觀察圍術(shù)期應用活血化瘀和艾司洛爾對高齡骨傷患者的心肌保護的療效分析。方法:選擇我院年齡≥60歲,臨床已確診的缺血性心肌病、冠心病的下肢骨折擇期行手術(shù)治療的患者120例,采用隨機對照分為4組,分別為空白對照組(C組)、活血化瘀組(H組)、艾司洛爾組(β組)、活血化瘀+艾司洛爾組(Hβ組),每組30例。C組麻醉誘導給予安慰劑持續(xù)泵注直至手術(shù)結(jié)束,H組術(shù)前5天開始口服"七味三七口服液",手術(shù)當日停用,術(shù)后第2天開始服用直至術(shù)后10天。β組麻醉誘導后持續(xù)泵注艾司洛爾(1mg/kg/h)直至手術(shù)結(jié)束,Hβ組術(shù)前5天開始口服"七味三七口服液",手術(shù)當日停用,術(shù)后第2天開始服用直至術(shù)后10天。麻醉誘導后持續(xù)泵注艾司洛爾(1mg/kg/h)直至手術(shù)結(jié)束。每組患者在入院當天、術(shù)前1天,術(shù)后1天,術(shù)后10天檢測缺血修飾白蛋白(IMA),在術(shù)中記錄每組各時點(入室、給氧誘導、插管、手術(shù)開始、術(shù)中10分鐘、20分鐘、30分鐘、手術(shù)結(jié)束、拔管)的ST段和心肌耗氧量(心肌耗氧量=收縮壓×心率)的變化。結(jié)果:在組內(nèi)比較H組、β組、Hβ組的IMA值在術(shù)后1天、10天與入院當天相比較明顯降低,具有統(tǒng)計學意義(P0.05)。在組間比較組間比較H組、β組、Hβ組的IMA值在手術(shù)后1天、10天分別與C組比較明顯降低,具有統(tǒng)計學意義(P0.05),H組和β組的IMA值之間比較無明顯差異,但Hβ組在術(shù)后1天、10天分別與H組、β組比較IMA值有上升趨勢,IMA值的異常率增高。術(shù)中各時點H組、β組、Hβ組的ST段值的異常率分別與C組比較具有統(tǒng)計學差意義(P0.05),但H組、β組、Hβ組三組分別比較無明顯差異。術(shù)中各時點H組、β組、Hβ組的心肌耗氧量與C組比較有下降趨勢,但這四組之間比較無統(tǒng)計學差異。結(jié)論:初步研究發(fā)現(xiàn)圍術(shù)期應用活血化瘀和艾司洛爾對高齡骨傷患者可減少術(shù)中及術(shù)后早期心肌損傷發(fā)生率,可提高高齡骨傷患者心血管穩(wěn)定性及高心肌耗氧量的耐受能力,從而起到心肌保護作用。但同時使用活血化瘀和艾司洛爾則降低相互之間的心肌保護作用療效。
[Abstract]:Objective: to observe the effect of promoting blood circulation and removing blood stasis and esmolol on myocardial protection in elderly patients with bone injury. Methods: 120 patients with ischemic cardiomyopathy and coronary heart disease, aged more than 60 years, were selected and randomly divided into 4 groups. There were 30 cases in each group, 30 cases in group C, 30 cases in group C and 30 cases in group C received continuous infusion of placebo until the end of operation, 5 cases in group H before operation. The day began to take "Qiwei Sanqi Oral liquid", which was stopped on the day of operation. The patients in the 尾 group received continuous infusion of esmolol (1 mg / kg 路kg / h) after anesthesia induction until the end of the operation, 5 days before the operation and 5 days before the operation, the group took "Qiwei Sanqi Oral liquid", which was stopped on the day of operation. Take it on the second day of operation until 10 days after operation. After anesthesia induction, continuous infusion of esmolol 1 mg / kg / h until the end of the operation. The patients in each group were examined for IIA on admission day, 1 day before operation, 1 day after operation and 10 days after operation. Each group was recorded at each time point (room entry, oxygen induction, intubation, operation beginning, 10 minutes, 20 minutes, 30 minutes) during operation. Changes of St segment and myocardial oxygen consumption (myocardial oxygen consumption = systolic pressure 脳 heart rate) at the end of operation. Results: the IMA value of H 尾 group was significantly lower than that of H 尾 group on the 1st and 10th day after operation compared with the admission day, which was statistically significant (P 0.05). The IMA of H 尾 group was significantly lower than that of C group on the 1st and 10th day after operation. There was no significant difference in IMA between P 0.05 group and 尾 group. However, the abnormal rate of IMA in H 尾 group was higher than that in H group on the 1st and 10th day after operation. The abnormal rate of St segment in H group and 尾 group was significantly lower than that in group C (P 0.05), but there was no significant difference between H group and H 尾 group. The myocardial oxygen consumption of H group and 尾 group H 尾 decreased significantly compared with that of group C, but there was no significant difference among these four groups. Conclusion: the preliminary study found that the perioperative application of promoting blood circulation and removing blood stasis and esmolol can reduce the incidence of myocardial injury during and after operation in elderly patients, and can improve the cardiovascular stability and tolerance of high myocardial oxygen consumption in elderly patients with bone injury. Thus, it plays a protective role in myocardium. However, combined use of blood circulation and blood stasis and esmolol reduced the myocardial protective effect between each other.
【作者單位】： 四川省骨科醫(yī)院麻醉科;
【基金】：四川省骨科醫(yī)院院內(nèi)課題—菱形阻滯結(jié)合中醫(yī)藥治療髕股關(guān)節(jié)病的臨床療效研究(編號:2015-27)
【分類號】：R687.3

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