摘要
目的 研究法乐四联症(TOF)患者术后早期血流动力学变化规律,探讨术后低心排趋势的监测方法与防治措施。方法 TOF患者20例,平均年龄(3.35±0.43)岁,均接受一期根治手术。术后随机分为2组,分别使用多巴胺和磷酸二酯酶Ⅲ(PDE-Ⅲ)抑制剂(米力农)改善心功能。通过热稀释法监测血流动力学,于术后3、9、24、48h测定心排量、混合静脉血氧饱和度及体、肺血管阻力,以术后3h数据为基础值。结果 术后9h多巴胺组心指数下降12.4％(P<0.01),米力农组心指数下降7.0％(P<0.05)。术后24h二组心指数接近基础值(P>0.05)。术后米力农组心排量改善优于多巴胺组(P<0.05),其体循环、肺循环阻力指数低于多巴胺组(P<0.01,P<O.05)。结论 TOF患者术后早期存在不同程度低心排趋势,PDE-Ⅲ抑制剂米力农的使用将有利于防治术后低心排。
Objective Haemodynamic changes in the early post -operative period of Tetrology of Fallot ( TOF) were investigated, with the aim to discuss the prevention and treatment strategy for low cardiac output (LCO). Methods Twenty children with TOF,age 3.35±0.43 years, who underwent primary corrective procedure were selected. Patients were devided into two groups according to the intropic agents administrated, dopamine or milrinone. Cardiac index (CI), the mixed venous oxygen saturation ( SvO2 ) , systemic and pulmonary vascular resistance index (SVRI, PVRI) were estimated by the thermodi-lution method at 3 , 9, 24, 48 hours after operation. The data of 3h post -operation was considered as the baseline. Results Nine hours after surgery, cardiac index (CI) decreased 12.4% and 7.0% in Dopamine group and milrinone group respectively, compared with the baseline value ( P < 0. 01, P < 0. 05 ) . 24h after surgery, CI in both groups had no difference compared to the baseline values (P > 0. 05 ) . Milrinone group had higher CI (P <0. 05) and lower SVRI, than Dopamine group. Conclusion There will be a tendency of LCO with different extent in the early post - operative period of TOF. Milrinone, a phosphodi-esterase -Ⅲ(PDE -Ⅲ) inhibitor, is useful to the prevention and treatment of post - operative LCO.
出处
《上海第二医科大学学报》
CSCD
2003年第B10期49-51,共3页
Acta Universitatis Medicinalis Secondae Shanghai
关键词
法乐氏四联症
术后
早期
低心排趋势
防治
Tetralogy of Fallot
low cardiac output
phosphodiesterase - Ⅲ inhibitor
milrinone
