摘要
目的通过测定血浆脑钠肽(BNP)及心肌蛋白酶水平辅助评价行非体外循环下冠状动脉旁路移植术(OPCABG)患者麻醉诱导期以琥珀酰明胶注射液行急性高容量填充时不同填充策略对患者心功能和术后恢复情况的影响。方法将40例行择期OPCABG的男性患者随机分入两组。麻醉诱导后置入Swan-Ganz导管测得心脏指数(CI)基础值,即行容量填充:经验法容量填充组于切皮前30min静脉输注琥珀酰明胶注射液12mL/kg;目标靶控填充组于切皮前静脉输注琥珀酰明胶注射液0.4mL·kg-1·min-1直至CI进入平台期即停止输注。分别于患者入手术室(T1)、容量填充前(T2)、容量填充中(T3)、容量填充后(T4)、各血管吻合完毕(T5)、手术结束时(T6)及术后24h(T7)各时间点采集3mL静脉血检测血浆BNP。记录术后3d的心肌蛋白酶水平。同时记录液体输注总量、术后气管导管拔管时间、重症监护病房(ICU)停留时间、术后住院天数和总住院天数。结果经验法容量填充组用于麻醉诱导期容量填充的琥珀酰明胶注射液量显著少于目标靶控填充组(P<0.05),在T7时间点的血浆BNP水平显著高于目标靶控填充组同时间点(P<0.05),在术后1、2d的肌酸激酶同工酶及术后2d的肌钙蛋白I水平均显著高于目标靶控填充组同时间点(P值分别<0.05、0.01),术后气管导管拔管时间、ICU停留时间均显著长于目标靶控填充组(P值分别<0.05、0.01)。结论行OPCABG患者在麻醉诱导时,以CI反馈施行目标靶控的容量填充安全、有效。通过测定血浆BNP及心肌蛋白酶水平可证实目标靶控容量填充法对心功能的影响较小,使扩容更为安全、有效。优化的填充策略有利于"快通道"的实施和术后恢复。
Objective To measure the plasma concentrations of brain natriuretic peptide （BNP） and myocardial proteinase so as to investigate the effects of hypervolemic infusion of succinylated gelatin by different strategies on cardiac function during off-pump coronary artery bypass graft （OPCABG）. Methods Forty patients scheduled for OPCABG were randomly divided into two groups. After induction, the basic cardiac index （CI） was obtained by Swan-Ganz. Group I （n--20）.. 12 mL/kg of succinylated gelatin injection was infused within 30 minutes. GroupⅡ （n = 20）= 0.4 mL . kg-1 min-1 of succinylated gelatin injection was infused until Cl achieved the steady state. The plasma concentrations of BNP and the dosage of fluid used were assessed on baseline （T1）, before fluid expansion （T2）, during fluid expansion （T3）, at the end of fluid expansion （T4）, after all bypass blood vessels de-clamped （Ts）, at the end of surgery （T6）, and 24 hours after surgery （T7）. The plasma concentrations of myocardial proteinase were recorded within 3 days after surgery. The duration of tracheal intubation, intensive care unit （ICU） stay and hospital stay were also recorded. Results The amount ofsuccinylated gelatin injection used in group I was significantly less than that in group Ⅱ（P〈0.05）. The plasma concentration of BNP at T7 in group I was significantly higher than that in group Ⅱ （P〈0.05）. The piasma concentrations of creatine kinase isoenzyme （CK-MB） and troponin I in group I were significantly higher than those in group H one and twodays after surgery （P〈0.05, 0.01）. The duration of tracheal intubation and ICU stay in group I were significantly longer than groupⅡ （P 〈 0. 05, 0. 01 ）. Conclusion Adequate volume expansion with succinylated gelatin infusion after induction of anesthesia is beneficial to cardiac insufficient patients undergoing OPCABG. The fluid expansion guided by BNP level is safer and more efficient than estimated amount of fluid infusion based on clinical experierane. This process can also shorten the time to tracheal extubation and ICU stay.
出处
《上海医学》
CSCD
北大核心
2013年第2期117-122,共6页
Shanghai Medical Journal
关键词
容量填充
非体外循环下冠状动脉旁路移植术
脑钠肽
心肌蛋白酶
Hypervolemic hemodilution Off-pump coronary artery bypass graft Brain natriuretic peptideMyocardial proteinase
