發(fā)布時(shí)間：2018-05-30 17:28

  本文選題：尼卡地平 + 體外循環(huán)��； 參考：《實(shí)用醫(yī)學(xué)雜志》2015年20期

【摘要】：目的:通過(guò)監(jiān)測(cè)尼卡地平對(duì)體外循環(huán)心臟手術(shù)患者胃黏膜血流變化、全身血流動(dòng)力學(xué)指標(biāo)、氧合指數(shù)的變化,探討其對(duì)患者胃腸灌注的影響。方法:選取2014年1-12月在本院心臟外科行冠脈旁路移植加瓣膜置換的患者42例,按隨機(jī)數(shù)字法分為尼卡地平組(N組)和對(duì)照組(C組),每組21例。兩組患者行常規(guī)誘導(dǎo)麻醉后行右頸靜脈穿刺,并插入Swan-Ganz導(dǎo)管,經(jīng)胃鏡引導(dǎo)下置入胃張力計(jì),24 h連續(xù)監(jiān)測(cè)患者胃部二氧化碳分壓(Pg CO2)。對(duì)照組術(shù)中行常規(guī)靜脈麻醉及體外循環(huán)方法 ;觀察組患者麻醉誘導(dǎo)后以0.5μg/(kg·min)的速度持續(xù)泵入尼卡地平,術(shù)中維持平均動(dòng)脈壓(MAP)≥70 mm Hg。持續(xù)監(jiān)測(cè)患者術(shù)中血流動(dòng)力學(xué)指標(biāo)。分別于患者體外循環(huán)前(T1)、開(kāi)始轉(zhuǎn)機(jī)后30 min(T2)、停機(jī)后30 min(T3)以及手術(shù)結(jié)束時(shí)(T4)測(cè)定患者靜脈血氧飽和度(Sv O2),抽取動(dòng)脈血測(cè)定血?dú)夥治鲇?jì)算氧供(DO2),氧耗(VO2),計(jì)算胃黏膜內(nèi)動(dòng)脈血CO2分壓差(Pg-a CO2)。結(jié)果 :血流動(dòng)力學(xué):兩組患者T3、T4時(shí)點(diǎn)心臟指數(shù)(CI)均高于T1(P0.05)。N組患者T3、T4時(shí)點(diǎn)CI顯著高于對(duì)照組(P0.05);N組在T2、T3、T4時(shí)點(diǎn)SVRI(全身血管阻力指數(shù))顯著低于T1(P0.05),且N組T3、T4時(shí)點(diǎn)SVRI低于C組(P0.05)。氧合指數(shù):兩組患者Sv O2在T2時(shí)較T1顯著升高,而C組在T3、T4時(shí)較T1顯著下降,在T4時(shí)點(diǎn)N組顯著高于C組(P0.05)。在T3、T4時(shí)點(diǎn)C組DO2,VO2與基礎(chǔ)值相比變化不明顯,而N組DO2顯著高于基礎(chǔ)值(P0.05)。C組在T3、T4時(shí)點(diǎn)Pg CO2與Pg-a CO2較T1顯著升高,且顯著高于N組(P0.05)。結(jié)論:尼卡地平能有效改善心臟血管術(shù)患者體外循環(huán)中氧合障礙、胃腸組織低灌注,減少對(duì)胃腸黏膜低血流灌注的損傷。
[Abstract]:Aim: to investigate the effects of nicardipine on gastrointestinal perfusion in patients undergoing cardiopulmonary bypass (CPB) by monitoring the changes of gastric mucosal blood flow, systemic hemodynamics and oxygenation index. Methods: Forty-two patients undergoing coronary artery bypass grafting and valve replacement in our hospital from January to December 2014 were randomly divided into nicardipine group (n = 21) and control group (n = 21). Right jugular vein puncture was performed after routine induction anesthesia in both groups, and Swan-Ganz catheter was inserted. Gastric tensor was placed under gastroscopy for 24 hours to continuously monitor the partial pressure of carbon dioxide in the stomach of the patients. In the control group, intravenous anesthesia and cardiopulmonary bypass were performed during the operation, and the patients in the observation group were continuously pumped into nicardipine at a speed of 0.5 渭 g/(kg after anesthesia induction, and the mean arterial pressure (MAPP) during the operation was 鈮，

本文編號(hào)：1956172