摘要
目的探讨风心病合并肺动脉高压患者在围术期治疗中前列腺素E1(PGE1)的作用规律,为临床提供理论依据。方法28例分为2组:实验组(A组)14例,于术中停体外循环(CPB)后开始应用PGE1,20ng.kg-1.min-1,之后每10分钟增加20ng.kg-1.min-1,直至100ng.kg-1.min-1维持10min,连续观察体肺循环压力变化,间隔10min测量心脏指数(CI)1次,共测量6次;其中7例(A1)术后24h重复上述操作1次,其余7例(A2)采用生理盐水作为对照;对照组(B组)14例,术中及手术当日均不使用前列腺素E1,其中7例(B1)术后24h按A组方法给药1次,其余7例(B2)采用生理盐水作为对照。术后24h实验组14例(C组=A1+B1),对照组14例(D组=A2+B2)。结果术中A组和B组平均肺动脉压(MPAP)下降比较相差不显著(P>0.05),心脏指数(CI)、体循环阻力(SVR)、肺循环阻力(PVR)、肺动脉楔压(PAWP)变化均无显著性差异(P>0.05);术后24hC、D组平均肺动脉压(MPAP)下降相差显著(P<0.05),两组心脏指数(CI)变化相差非常显著(P<0.01)。结论风心病合并肺动脉高压患者在瓣膜置换术后,麻醉状况下对前列腺素E1存在抵抗现象,而在清醒状况下前列腺素E1能扩张肺血管,降低肺动脉压,提高心脏指数,改善心功能。
Objective To study the rule of surgical treatment for rheumatic heart disease in the postoperative stage of valve replacement. Methods Twenty-eight cases, suffered from rheumatic heart disease, were randomly divided into two groups, group A and B. In group A, 14 cases were given 20 - 100 ng· kg^-1· min^-1 of prostaglandin E1 （PGE1） after the cardiopulmonary bypass （CPB） was stopped, and its velocity （dosage） was increased by 20 ng · kg^-1· min^-1 every 10 minutes. When up to 100 ng · kg^-1· min^-1, the velocity was held on for 10 minutes, then seized. PGE1 was swapped when it was used for 1 h. Twenty-four hours later, 7 cases of group A （A1） were given PGE1 once more as the same as the day before; the other 7 cases （A2） were given normal saline instead as for controls. In group B, no cases were given PGE1 during operation or on the day of operation. Twenty-four hours later, 7 cases （B1） were given PGE1 as that of A1, and the other 7 cases （B2） as that in group A2. In the hour of PGE1 injection, the blood pressure （SABP, DABP, MABP）, pulmonary pressure （SPAP, DPAP, MPAP, PAWP）, systemic vascular resistance （SVR）, and pulmonary vascular resistance （PVR） were measured via Swan-Ganz catheter. Results There was not significant difference of parameters mentioned above between group A and group B. Twenty-four hours after operation, MPAP, PAWP and PVR in group C （A1 ＋ B1 ） were much lower than those in group D （ A2 ＋ B2）. Conclusion The effect of PGE1 on pressure of pulmonary artery could not be seen when the patients were in anesthesia, so during mitral replacement operation it might be of some resistance.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2007年第9期792-795,共4页
Journal of Third Military Medical University
关键词
风心病
肺动脉高压
前列腺素E2
rheumatic heart disease
pulmonary hypertension
PGE1
