摘要
目的:探讨术中雾化吸入米力农与静脉注射米力农对行二尖瓣手术的肺动脉高压患者血流动力学的影响。方法:纳入2020年9月至2022年12月与该院治疗的二尖瓣狭窄合并肺动脉高压患者152例,根据随机数字表法分为吸入组(n=76)和静脉注射组(n=76)。吸入组、静脉注射组患者在术中分别给予雾化吸入米力农、静脉注射米力农治疗。比较吸入组与静脉注射组患者胸骨切开前(T_(0))、心脏手术体外循环(CPB)撤机后(T_(1))和患者转移至重症监护室前(T_(2))的肺毛细血管楔压(PCWP)、平均动脉压(MAP)、平均肺动脉压(MPAP)、心脏指数(CI)和肺血管阻力指数(PVRI)等血流动力学指标。比较两组患者T_(0)、T_(1)和T_(2)时的动脉血氧分压(PaO_(2))/吸入气中的氧浓度(FiO_(2))、混合静脉血氧饱和度(SvO_(2))及肺内分流率(Qs/Qt)等动脉血气指标。比较两组患者T_(0)、T_(1)、T_(2)时的三尖瓣环收缩期位移(TAPSE)、右心室面积变化分数(RVFAC)等超声心动图指标。结果:与T_(0)时比较,吸入组和静脉注射组患者在T_(1)和T_(2)时的PCWP、MAP、MPAP及PVRI显著降低,CI显著升高,差异均有统计学意义(P<0.05)。T_(1)和T_(2)时,吸入组患者的PCWP、MPAP和PVRI显著低于静脉注射组同期,CI显著高于静脉注射组同期;但静脉注射组患者的MAP较吸入组同期显著降低,差异均有统计学意义(P<0.05)。与T_(0)时比较,吸入组与静脉注射组患者在T_(1)和T_(2)时的PaO_(2)/FiO_(2)显著升高,Qs/Qt显著降低,差异均有统计学意义(P<0.05)。吸入组患者在T_(1)和T_(2)时PaO_(2)/FiO_(2)较静脉注射组同期显著升高,Qs/Qt显著降低,差异均有统计学意义(P<0.001)。与T_(0)时比较,吸入组患者T_(1)和T_(2)时的TAPSE、RVFAC显著升高,差异均有统计学意义(P<0.05)。在T_(1)和T_(2)时,吸入组患者TAPSE、RVFAC较静脉注射组同期显著升高,差异均有统计学意义(P<0.001)。结论:二尖瓣狭窄合并肺动脉高压患者
OBJECTIVE:To probe into the effect of milrinone for nebulized inhalation and intravenous injection on hemodynamics in patients with pulmonary hypertension undergoing mitral valve surgery in perioperative period.METHODS:Totally 152 patients with mitral stenosis complicated with pulmonary hypertension admitted into this hospital from Sept.2020 to Dec.2022 were enrolled and divided into inhalation group(n=76) and intravenous injection group(n=76) via the random number table method.The inhalation group and intravenous injection group were given milrinone for inhalation and intravenous injection during the surgery,respectively.The hemodynamics indicators including pulmonary capillary wedge pressure(PCWP),mean arterial pressure(MAP),mean pulmonary arterial pressure(MPAP),cardiac index(CI) and pulmonary vascular resistance index(PVRI) were compared between two groups before sternotomy(T_(0)),after cardiopulmonary bypass(CPB) withdrawn(T_(1)) and before the patient transferred to intensive care unit(T_(2)).The arterial blood gas indicators including arterial partial pressure of oxygen(PaO_2)/fraction of inhaled oxygen(FiO_2),mixed venous blood oxygen saturation(SvO_2) and intrapulmonary shunt(Qs/Qt) were compared between two groups at T_(0),T_(1) and T_(2).The ultrasonic cardiogram including tricuspid annular plane systolic excursion(TAPSE) and right ventricular fractional area change(RVFAC) were compared between two groups at T_(0),T_(1) and T_(2).RESULTS:Compared with T_(0),the PCWP,MAP,MPAP and PVRI of the inhalation group and the intravenous injection group were significantly lower at T_(1) and T_(2),while the CI was significantly increased,with statistically significant differences(P<0.05).At T_(1) and T_(2),the PCWP,MPAP and PVRI values of the inhalation group were significantly lower than those of the intravenous injection group at the same period,and the CI was significantly higher than that of the intravenous injection group at the same period;while the MAP of the intravenous injection group were significantly l
作者
史文雯
卢群
田刚
高晓岗
SHI Wenwen;LU Qun;TIAN Gang;GAO Xiaogang(Dept.of Pharmacy,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Dept.of Cardiology,the First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)
出处
《中国医院用药评价与分析》
2023年第9期1066-1070,共5页
Evaluation and Analysis of Drug-use in Hospitals of China
基金
2020年陕西省卫生健康委员会卫生健康科研项目(No.2020D328)。
关键词
米力农
雾化吸入
二尖瓣手术
肺动脉高压
血流动力学
Milrinone
Atomization inhalation
Mitral valve surgery
Pulmonary hypertension
Hemodynamics
