CAJ | 학술논문

目的探讨左西孟坦对合并肺动脉高压二尖瓣置换术患者肺动脉压的影响.方法择期合并肺动脉高压的二尖瓣置换术患者24例,年龄35 ～ 60岁,ASA分级Ⅱ级或Ⅲ级,NYHA心功能分级Ⅱ级或Ⅲ级,平均肺动脉压(MPAP)＞ 30 mm Hg.采用随机数字表法,将其随机分为2组(n=12):对照组(C组)和左西孟坦组(L组).L组于主动脉开放后静脉注射左西孟坦负荷量24 μg/kg,随后以0.2 μg·kg-1·min-1的速率静脉输注至术后1 d;C组给予等容量生理盐水.于麻醉诱导后5 min(T0)、停机即刻(T1)和术后1 h(T2)时记录HR、MAP、MPAP、肺毛细血管嵌压和CI,计算肺血管阻力(PVR)及RPP.记录肺动脉高压改善情况.结果与T0时比较,2组T1,2时PCWP降低,CI升高,C组T1,2时HR升高,T2时MPAP降低,L组T1,2时MPAP和PVR降低(P＜0.05)；与C组比较,L组T1.2时HR、MPAP、PVR降低,CI升高,T2时RPP降低,肺动脉高压改善率升高(P＜0.05).结论对于合并肺动脉高压的二尖瓣置换术患者,左西孟坦在不增加心肌氧耗,增强心肌收缩力的同时还可改善肺动脉高压.
목적 탐토좌서맹탄대합병폐동맥고압이첨판치환술환자폐동맥압적영향.방법 택기합병폐동맥고압적이첨판치환술환자24례,년령35 ～ 60세,ASA분급Ⅱ급혹Ⅲ급,NYHA심공능분급Ⅱ급혹Ⅲ급,평균폐동맥압(MPAP)＞ 30 mm Hg.채용수궤수자표법,장기수궤분위2조(n=12):대조조(C조)화좌서맹탄조(L조).L조우주동맥개방후정맥주사좌서맹탄부하량24 μg/kg,수후이0.2 μg·kg-1·min-1적속솔정맥수주지술후1 d;C조급여등용량생리염수.우마취유도후5 min(T0)、정궤즉각(T1)화술후1 h(T2)시기록HR、MAP、MPAP、폐모세혈관감압화CI,계산폐혈관조력(PVR)급RPP.기록폐동맥고압개선정황.결과 여T0시비교,2조T1,2시PCWP강저,CI승고,C조T1,2시HR승고,T2시MPAP강저,L조T1,2시MPAP화PVR강저(P＜0.05)；여C조비교,L조T1.2시HR、MPAP、PVR강저,CI승고,T2시RPP강저,폐동맥고압개선솔승고(P＜0.05).결론 대우합병폐동맥고압적이첨판치환술환자,좌서맹탄재불증가심기양모,증강심기수축력적동시환가개선폐동맥고압.
Objective To investigate the effect of levosimendan on pulmonary artery pressure in patients with pulmonary hypertension undergoing mitral valve replacement.Methods Twenty-four ASA Ⅱ or Ⅲ and NY-HA class Ⅱ or Ⅲ patients,aged 35-60 yr,with mean pulmonary artery pressure (MPAP) ＞ 30 mm Hg,undergoing mitral valve replacement were randomly divided into 2 groups (n =12 each):control group (group C) and levosimendan group (group L).In group L,a loading dose of levosimendan 24 μg/kg was injected intravenously after aortic unclamping,followed by infusion of levosimendan at a rate of 0.2 μg· kg-1 · min-1 until 1 d after operation.Group C received the equal volume of normal saline.HR,MAP,MPAP,pulmonary capillary wedge pressure (PCWP),cardiac index (CI) were recorded at 5 min after induction (T0),at the end of CPB (T1) and at 1 h after operation (T2),and the pulmonary vascular resistance (PVR) and rate-pressure product (RPP) were calculated.The improvement in pulmonary hypertension was recorded.Results PCWP was significantly lower and CI higher at T1,2 in both groups,and HR was significantly higher at T1,2 and MPAP lower at T2 in group C,and MPAP and PVR were significantly lower at T1,2 in group L than at T0 (P ＜ 0.05).HR,MPAP and PVR were significantly lower and CI was significantly higher at T1,2,RPP was significantly lower at T2 and the improvement in pulmonary hypertension was higher in group L than in group C (P ＜ 0.05).Conclusion Levosimendan can improve pulmonary hypertension without increasing the myocardial oxygen consumption and with a significant increase in myocardial contractility in patients with pulmonary hypertension undergoing mitral valve replacement.