本文關(guān)鍵詞： 艾司洛爾 體外循環(huán) 心臟瓣膜置換術(shù) 心肌肌鈣蛋白Ⅰ　出處：《廣西醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 觀察體外循環(huán)(CPB)期間應(yīng)用艾司洛爾,對停跳心臟瓣膜置換患者圍術(shù)期血清心肌肌鈣蛋白I (cTn-I)的變化影響,探討其應(yīng)用是否能減輕心肌損傷,有利于術(shù)后心功能的恢復(fù)。方法 在我院符合研究條件、年齡18～70歲擇期行體外循環(huán)心臟停跳下行心臟瓣膜置換手術(shù)患者中,按數(shù)字隨機法選擇48例患者,再隨機分為兩組,每組各24例,實驗組為A組(艾司洛爾),對照組為C組。A組患者在體外循環(huán)開始時及主動脈開放前1分鐘,分別經(jīng)體外循環(huán)膜肺給藥管路給予艾司洛爾注射液2mg/kg, C組在體外循環(huán)開始時及主動脈開放前1分鐘,分別經(jīng)體外循環(huán)膜肺給藥管路給予等容量的生理鹽水。在體外循環(huán)開始前(T1)、術(shù)后1h (T2)、24h (T3)和48h(T4),經(jīng)靜脈采血檢測血清心肌肌鈣蛋白I (cTn-I)的數(shù)值；記錄患者主動脈阻斷時間、轉(zhuǎn)機時間、手術(shù)時間、術(shù)后呼吸機支持時間、CCU的住院時間、術(shù)后住院時間；觀察記錄患者升主動脈開放后心臟復(fù)跳情況；術(shù)畢時正性肌力藥物使用情況。應(yīng)用SPSS 16.0軟件行統(tǒng)計分析,計量資料以x±s表示,兩樣本均數(shù)檢驗用t檢驗,多個樣本均數(shù)檢驗用重復(fù)測量方差分析,兩計數(shù)資料比較用χ2檢驗,以α=0.05檢測水平,p0.05為有統(tǒng)計學(xué)差異。結(jié)果 兩組患者年齡、性別、術(shù)前心功能分級、術(shù)式等無統(tǒng)計學(xué)差異；兩組患者的主動脈阻斷時間、轉(zhuǎn)機時間、手術(shù)時間、術(shù)后呼吸機支持時間、術(shù)后CCU的住院時間、術(shù)后住院時間無統(tǒng)計學(xué)差異。A組中自動復(fù)跳23例(23/24,95.8%),高于C組16例(16/24,67%) (X2=24,p=0.042)。術(shù)畢時,多巴胺注射速度A組：4.71±1.30μg/kg/min,C組：4.46±1.0μg/kg/min(P0.05)。A組合用腎上腺素的例數(shù)為3/24(12.5%)少于C組12/24(500,6) (χ2=15.73,P=0.000)；A組術(shù)畢腎上腺素注射速度為0.005±0.013μg/kg//min,低于C組0.014±0.016μg/kg/min(t=2.42,P0.05)；在術(shù)后1h(T2).24h(T3)和48h(T4),兩組患者的血清cTn-I值均較T1明顯升高,其中在T3達最高值。但在術(shù)后24h(T3),A組的血清cTn-I值為10.93±4.50μg/L,低于C組的血清cTn-I值19.07±5.06pg/L(t=5.89,P0.05):在術(shù)后48h(T4),A組的血清cTn-I值為9.06±3.87μg/L,也低于C組的血清cTn-I值15.97±4.43μg/L(t=5.75,P0.05).結(jié)論停跳心臟瓣膜置換術(shù)患者CPB開始及升主動脈開放前1分鐘,給予艾司洛爾2mg/kg的劑量,提高心臟的自動復(fù)跳率,可減輕心肌損傷,對術(shù)后心功能的恢復(fù)有積極作用。
[Abstract]:Objective to observe the effect of esmolol on serum cardiac troponin I (cTn-I) in patients undergoing cardiac valve replacement during cardiopulmonary bypass (CPB). To explore whether the application can alleviate myocardial injury and facilitate the recovery of cardiac function after operation. 48 patients (1870 years old) undergoing cardiac valve replacement under cardiopulmonary bypass (CPB) were randomly divided into two groups (24 cases in each group). Group A (group A), group C (group C) and group A (group C) at the beginning of cardiopulmonary bypass (CPB) and one minute before aortic opening. Two mg / kg esmolol injection was given through the pulmonary tube of cardiopulmonary bypass respectively. Group C was given at the beginning of cardiopulmonary bypass and one minute before the aorta was opened. Normal saline was given to the lung through the membrane of cardiopulmonary bypass (CPB). Before CPB, T1 was given before CPB, and T3 at 1h after CPB and T3 at 48h after CPB. The serum cardiac troponin I (cTn-I) was measured by intravenous blood sampling. The time of aortic clamping, transit time, operation time, postoperative ventilator support time and hospitalization time of CCU were recorded. The cardiac resuscitation was recorded after the ascending aorta was opened. SPSS 16.0 software was used to do statistical analysis. The metrological data were expressed as x 鹵s, and the mean of two samples was tested by t test. Multiple sample mean test was performed by repeated analysis of variance, 蠂 2 test was used to compare the two counting data, and there was significant difference between the two groups in terms of 偽 -0.05 level (p 0.05). Results the age and sex of the two groups were significantly higher than those of the control group. There was no significant difference in preoperative cardiac function grading and operative methods. The aortic clamping time, transit time, operation time, postoperative ventilator support time, postoperative CCU hospitalization time of the two groups. There was no significant difference in postoperative hospital stay. In group A, 23 cases of spontaneous resuscitation were 23 / 2495.8, which was higher than that of group C (16 / 16 / 24 / 67). At the end of the operation, the dopamine injection rate in group A was 4.71 鹵1.30 渭 g / kg / min. Group C: 4.46 鹵1.0 渭 g / kg / kg P0.05A was less than group C in the number of cases of epinephrine (3 / 24 / 12.5a) than in group C (12 / 24 / 24 / 500). (6) (蠂 2 = 15.73) (P = 0.000); The injection rate of epinephrine in group A was 0.005 鹵0.013 渭 g / kg / min after operation, which was lower than that in group C (0.014 鹵0.016 渭 g / kg / kg / min). P0.05; The serum cTn-I levels in both groups were significantly higher than those in T1 at 1 h after operation, and at 24 h after operation, and reached the highest at T3, but at 24 h after operation, the serum cTn-I levels in both groups were significantly higher than those in T1, but at 24 h after operation, the serum cTn-I levels in both groups were significantly higher than those in T1. The serum cTn-I of group A was 10.93 鹵4.50 渭 g / L, which was lower than that of group C (19.07 鹵5.06pg / L). P0.05: the serum cTn-I of group A was 9.06 鹵3.87 渭 g / L at 48h after operation. The serum cTn-I of group C was also lower than that of group C (15.97 鹵4.43 渭 g / L). Conclusion in patients with cardiac valve replacement due to cardioplegia, 2 mg / kg of esmolol was given at the dose of 2 mg / kg at the beginning of CPB and 1 minute before the opening of ascending aorta, so as to increase the rate of automatic cardiac resuscitation. It can reduce myocardial injury and has a positive effect on the recovery of cardiac function after operation.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R614

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