摘要
目的观察静脉输注甲氧明和去氧肾上腺素对冠状动脉(冠脉)搭桥术患者麻醉诱导期血流动力学、心脏泵功能及心肌耗氧的影响。方法64例择期心肺转流下行冠脉搭桥术患者随机分为两组,每组32例。麻醉诱导期间,M组静脉泵注甲氧明3μg·kg^(-1)·min^(-1),P组静脉泵注去氧肾上腺素0.24μg·kg^(-1)·min^(-1),根据BP调整泵药速度,维持MAP波动在基础值的±20%。记录泵药前(T0)以及泵药后1 min(T1)、5 min(T2)、10 min(T3)和15 min(T4)的SBP、MAP、HR、心脏指数(CI)、心率收缩压乘积(RPP)、混合静脉血氧饱和度(SVO_(2))、氧供(DO_(2))、氧耗(VO_(2))。结果与T0时比较,M组、P组T1~T4时SBP、MAP无统计学差异(P>0.05);M组T2~T4时HR下降(P<0.01),P组T3时HR下降(P<0.01);P组T4时CI下降(P<0.05);M组T2~T4时RPP下降(P<0.01),P组T3时RPP下降(P<0.01);M组T2~T4时SVO_(2)上升(P<0.05或P<0.01);M组T3~T4时VO_(2)下降(P<0.05)。结论与去氧肾上腺素比较,麻醉诱导期静脉泵注甲氧明可以较好地维持冠脉搭桥术患者BP、HR和CI平稳,降低心肌和全身耗氧。
Objective To observe the effects of intravenous infusion of methoxamine or phenylephrine during anesthesia induction on hemodynamics,cardiac function and oxygen consumption in the patients undergoing coronary artery bypass grafting(CABG).Methods Sixty-four patients undergoing CABG were randomly assigned into 2 groups with 32 cases each.During anesthesia induction,methoxamine 3μg·kg^(-1)·min^(-1)was infused in group M and phenylephrine 0.24μg·kg^(-1)·min^(-1)was infused in group P,which were adjusted to keep the variations of MAP within±20%of the baseline.Hemodynamic indicators including SBP,MAP,HR,cardiac index(CI),rate-pressure product(RPP),mixed venous oxygen saturation(SVO_(2)),oxygen delivery(DO_(2))and consumption(VO_(2))were recorded before(T0)and at 1 minute(T1),5 minutes(T2),10 minutes(T3)and 15 minutes(T4)during infusion of methoxamine or phenylephrine.Results Compared with T0,SBP and MAP at T1-T4 were significantly unchanged in groups of M and P(P>0.05),HR was decreased at T2-T4 in group M(P<0.01),which was decreased only at T3 in group P(P<0.01).Compared with T0,CI at T1-T4 was unchanged significantly in group M(P>0.05),which was decreased at T4 in group P(P<0.05).Compared with T0,RPP was decreased at T2-T4 in group M(P<0.01),but was decreased only at T3 in group P(P<0.01).Compared with T0,SVO_(2) was increased at T2-T4 in group M(P<0.05 or P<0.01),and VO_(2) was decreased at T3-T4 in group M(P<0.05).ConclusionCompared to phenylephrine,intravenous infusion of methoxamine during anesthesia induction in the patients undergoing CABG has better effect in keeping BP,HR and CI stable and reducing myocardial and systemic oxygen consumption.
作者
卜心怡
王悠然
史宏伟
魏海燕
尹加林
施韬
苏中宏
葛亚力
BU Xinyi;WANG Youran;SHI Hongwei(Department of Anesthesiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,CHINA)
出处
《江苏医药》
CAS
2021年第1期73-76,共4页
Jiangsu Medical Journal
关键词
甲氧明
去氧肾上腺素
冠状动脉搭桥术
全身麻醉
Methoxamine
Phenylephrine
Coronary artery bypass grafting
General anesthesia
