摘要
目的探讨在瓣膜置换手术中升主动脉开放后出现顽固性心室颤动(室颤)时经主动脉根部灌注乙胺碘呋酮对手术效果的影响。方法选择2006年10月至2016年10月北京安贞医院心脏外科单一手术组行瓣膜置换术中主动脉开放后顽固性室颤患者42例作为药物组,其中男26例、女16例,年龄(56.31±12.56)岁,顽固性室颤时再次阻断升主动脉,应用乙胺碘呋酮(150 mg稀释至20 ml)经主动脉根部灌注管注入,并反复抽吸8~10次,累计总量约150~200 ml,然后开放升主动脉阻断钳,快速挤压升主动脉,频率约200次/min。选择同期其他手术组术中表现相同患者53例作为对照组,其中男35例、女18例,年龄(58.79±19.81)岁,顽固室颤时采取临床常用处理方法,如继续给予1 mg/kg利多卡因静脉推注,同时再次阻断升主动脉,给予温血灌注等方法,直至心脏复跳。比较两组临床结果。结果药物组围术期死亡1例,对照组围术期死亡2例。药物组除颤次数[(3.11±0.59)次vs.(4.91±1.34)次,t=–2.917,P=0.000]、复跳后室颤发生(2例vs.6例,χ2=5.213,P=0.000)、复跳5min后心率[(91.65±9.81)次/min vs.(98.32±10.21)次/min,t=–2.019,P=0.032]、体外循环辅助时间[(71.68±10.21)min vs.(81.59±12.93)min,t=–2.512,P=0.032]、多巴胺用量[(4.32±1.28)μg/(kg·min)vs.(5.79±1.98)μg/(kg·min),t=–2.781,P=0.015]、肾上腺素用量[(0.03±0.01)μg/(kg·min)vs.(0.06±0.02)μg/(kg·min),t=–3.996,P=0.000]和去甲肾上腺素用量[(0.01±0.01)μg/(kg·min)vs.(0.03±0.01)μg/(kg·min),t=–4.163,P=0.000]均短于或少于对照组,复跳5 min后窦性心律发生率高于对照组(42.8%vs.9.4%,χ~2=11.211,P=0.000)。结论在瓣膜置换术中主动脉开放后出现顽固性室颤的患者,通过再次阻断升主动脉,经停跳灌注管向主动脉根部再次灌注乙胺碘呋酮,可明显提高心脏复跳率和避免再次室颤的出现,缩短体外循环辅助时间,减少正性肌力药物的使用剂量,取得良好效果。
Objective To explore the effect of aortic root perfusion of amiodarone when intractable ventricular fibrillation occurs during valve replacement. Methods Totally 42 patients were selected as a drug group, who underwent intractable ventricular fibrillation following ascending aortic opening in valve replacement in Beijing Anzhen Hospital from October 2006 to October 2016. There were 26 males and 16 females with an average age of 56.31± 12.56 years. The aorta was re-blocked when intractable ventricular fibrillation occured, amiodarone （150 mg diluted to 20 ml） through the aortic root perfusion tube was applicated, and suction was repeated 8-10 times with the cumulative amount of 150-200 ml, and then the ascending aorta was opened and fast compressed with a frequency of 200 times/min. While 53 patients with the same condition during the same period were selected as a control group. There were 35 males and 18 females with an average age of 58.79±19.81 years. The commonly used clinical treatment method of intractable ventricular fibrillation was adopted, such as continuous intravenous injection of I mg/kg lidocaine, while ascending aortic was re-blocked. The warm blood perfusion was given until the heart re-beated. The clinical outcomes were compared between the two groups. Results There was one perioperative death in the drug group and two deaths in the control group during perioperative period. Defibrillation frequency （3.11±0.59 times vs. 4.91±1.34 times, t=-2.917,P=0.000）, heart rate 5 min after re-beating （91.65±9.81 beats/min vs. 98.32±10.21 beats/min, t=-2.019, P=0.032）, cardiopulmonary bypass time （71.68±10.21 min vs.81.5%k12.93 min, t=-2.512, P=0.032）, dopamine dosage （4.32±1.28 μg·kg-1.min-1 vs. 5.79±1.98 μg·kg-1·min-1, t=-2.781,P=0.015）, epinephrine dosage （0.03±0.01 μg·kg-1.min-1 vs. 0.06±0.02 μg.kg 1.min 1, t=-3.996, P=0.000） and norepinephrine dosage （0.01±0.01 μg·kg-1·min-1 vs. 0.03±0.01 μg·kg-1·min-1, t=-4.163, P=0.000） of the drug group were signi
作者
赵铁夫
王盛宇
陈宏
张春晓
张明
ZHAO Tiefu;WANG Shengyu;CHEN Hong;ZHANG Chunxiao;Zhang Ming(Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R.China)
出处
《中国胸心血管外科临床杂志》
CAS
CSCD
2018年第7期583-586,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
乙胺碘呋酮
心室颤动
瓣膜置换术
Amiodarone
ventricular fibrillation
valve replacement
