中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
1期
85-87
,共3页
寇党培%王准%边卫%韩建阁
寇黨培%王準%邊衛%韓建閣
구당배%왕준%변위%한건각
前列地尔%肺动脉%高血压,肺性
前列地爾%肺動脈%高血壓,肺性
전렬지이%폐동맥%고혈압,폐성
Alprostadil%Pulmonary artery%Hypertension,pulmonary
目的 探讨前列腺素E1肺动脉途径给药对肺动脉高压患者的降压效果.方法 择期行非体外循环冠状动脉搭桥术合并肺动脉高压患者30例,性别不限,年龄65 ～ 82岁,体重60 ～ 88 kg,ASA分级Ⅱ或Ⅲ级,肺动脉收缩压＞40 mm Hg.采用随机数字表法,将其随机分为2组(n=15):中心静脉给药组(C组)和肺动脉给药组(P组).麻醉诱导后行右颈内静脉穿刺置入Swan-Ganz导管用于监测血流动力学指标.切皮后,C组和P组分别通过中心静脉导管和肺动脉导管输注前列腺素E120 ～ 50 ng·kg-1 ·min-1,使肺动脉收缩压降至25～ 30 mm Hg.分别于给药前5 min(To)及给药后5 min(T1)记录心率、平均动脉压、中心静脉压、肺动脉收缩压、肺毛细血管楔压和心脏指数,计算肺血管阻力和周围血管阻力.记录前列腺素E1的用量.结果 与C组相比,P组前列腺素E1用量减少,T1时肺动脉收缩压和肺血管阻力降低,平均动脉压和周围血管阻力升高(P＜0.05).结论 经肺动脉途径给药可提高前列腺素E1降低肺动脉高压的效价,且不影响体循环血流动力学.
目的 探討前列腺素E1肺動脈途徑給藥對肺動脈高壓患者的降壓效果.方法 擇期行非體外循環冠狀動脈搭橋術閤併肺動脈高壓患者30例,性彆不限,年齡65 ～ 82歲,體重60 ～ 88 kg,ASA分級Ⅱ或Ⅲ級,肺動脈收縮壓＞40 mm Hg.採用隨機數字錶法,將其隨機分為2組(n=15):中心靜脈給藥組(C組)和肺動脈給藥組(P組).痳醉誘導後行右頸內靜脈穿刺置入Swan-Ganz導管用于鑑測血流動力學指標.切皮後,C組和P組分彆通過中心靜脈導管和肺動脈導管輸註前列腺素E120 ～ 50 ng·kg-1 ·min-1,使肺動脈收縮壓降至25～ 30 mm Hg.分彆于給藥前5 min(To)及給藥後5 min(T1)記錄心率、平均動脈壓、中心靜脈壓、肺動脈收縮壓、肺毛細血管楔壓和心髒指數,計算肺血管阻力和週圍血管阻力.記錄前列腺素E1的用量.結果 與C組相比,P組前列腺素E1用量減少,T1時肺動脈收縮壓和肺血管阻力降低,平均動脈壓和週圍血管阻力升高(P＜0.05).結論 經肺動脈途徑給藥可提高前列腺素E1降低肺動脈高壓的效價,且不影響體循環血流動力學.
목적 탐토전렬선소E1폐동맥도경급약대폐동맥고압환자적강압효과.방법 택기행비체외순배관상동맥탑교술합병폐동맥고압환자30례,성별불한,년령65 ～ 82세,체중60 ～ 88 kg,ASA분급Ⅱ혹Ⅲ급,폐동맥수축압＞40 mm Hg.채용수궤수자표법,장기수궤분위2조(n=15):중심정맥급약조(C조)화폐동맥급약조(P조).마취유도후행우경내정맥천자치입Swan-Ganz도관용우감측혈류동역학지표.절피후,C조화P조분별통과중심정맥도관화폐동맥도관수주전렬선소E120 ～ 50 ng·kg-1 ·min-1,사폐동맥수축압강지25～ 30 mm Hg.분별우급약전5 min(To)급급약후5 min(T1)기록심솔、평균동맥압、중심정맥압、폐동맥수축압、폐모세혈관설압화심장지수,계산폐혈관조력화주위혈관조력.기록전렬선소E1적용량.결과 여C조상비,P조전렬선소E1용량감소,T1시폐동맥수축압화폐혈관조력강저,평균동맥압화주위혈관조력승고(P＜0.05).결론 경폐동맥도경급약가제고전렬선소E1강저폐동맥고압적효개,차불영향체순배혈류동역학.
Objective To investigate the efficacy of prostaglandin E1 administered via the pulmonary artery for treatment of pulmonary hypertension in patients.Methods Thirty ASA Ⅱ or Ⅲ patients undergoing offpump coronary artery bypass grafting complicated with pulmonary hypertension,with pulmonary arterial systolic pressure (PASP) ＞ 40 mm Hg,were randomly divided into 2 groups (n =15 each):administration via the central vein group (group C) and administration via the pulmonary artery group (group P).Anesthesia was induced with midazolam,etomidate,cisatracurium and sufentanil.The patients were tracheal intubated and mechanically ventilated.Swan-Ganz catheter was placed via the right internal jugular vein for monitoring of hemodynamic parameters after induction of anesthesia.The central vein and pulmonary artery were cannulated for infusion of prostaglandin E1.Prostaglandin E1 was infused at a rate of 20-50 ng· kg-1 · min-1 starting from the end of skin incision until PASP was decreased to 20-30 mm Hg.Heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),PASP,pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) were recorded at 5 rain before administration (To) and 5 min after administration (T1).The pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) were calculated.The amount of prostaglandin E1 consumed was recorded.Results Compared with group C,the amount of prostaglandin E1 consumed was significantly reduced,PASP and PVR were decreased at T1,while MAP and SVR were increased at T1 in group P(P ＜ 0.05).Conclusion Administration via the pulmonary artery can increase the potency of prostaglandin E1 for treatment of pulmonary hypertension and exerts no influence on the systemic hemodynamics.
