CAJ | 학술논문

目的：观察风湿性心脏病( RHD)合并肺动脉高压( PH)患者在瓣膜置换术中应用尼可地尔对肺血流动力学的影响。方法行瓣膜置换术的RHD合并PH患者60例,随机分为2组,每组30例。观察组患者于麻醉前口服尼可地尔,对照组患者不给药。对2组患者的手术相关指标、体循环血液动力学指标及平均肺动脉压( MPAP)、肺循环阻力( PVR)等肺循环血流动力学指标进行观察和比较。结果观察组患者术中硝普纳用量显著低于对照组(t =3.673, P <0.05),而体外循环转流时间、主动脉阻断时间、手术时间、多巴胺用量、机械通气时间、术中出血量、术中补液量、围手术期尿量等差异均无统计学意义( P >0.05)；以术前( T0)为参照,在尼可地尔给药20 min( T1)、给药40 min(T2)、转流前(T3),观察组患者MPAP和PVR均显著下降( P <0.05),对照组未见显著下降( P >0.05),2组比较差异有统计学意义( P <0.05)；其他血液动力学指标组内差异有统计学意义( P <0.05),组间差异均无统计学意义( P >0.05)。结论在RHD合并PH患者瓣膜置换术中应用尼可地尔,可达到稳定患者转流期间的血液循环、降低其肺动脉压力和肺循环阻力的目的,有助于保障手术的治疗效果和安全性。
목적：관찰풍습성심장병( RHD)합병폐동맥고압( PH)환자재판막치환술중응용니가지이대폐혈류동역학적영향。방법행판막치환술적RHD합병PH환자60례,수궤분위2조,매조30례。관찰조환자우마취전구복니가지이,대조조환자불급약。대2조환자적수술상관지표、체순배혈액동역학지표급평균폐동맥압( MPAP)、폐순배조력( PVR)등폐순배혈류동역학지표진행관찰화비교。결과관찰조환자술중초보납용량현저저우대조조(t =3.673, P <0.05),이체외순배전류시간、주동맥조단시간、수술시간、다파알용량、궤계통기시간、술중출혈량、술중보액량、위수술기뇨량등차이균무통계학의의( P >0.05)；이술전( T0)위삼조,재니가지이급약20 min( T1)、급약40 min(T2)、전류전(T3),관찰조환자MPAP화PVR균현저하강( P <0.05),대조조미견현저하강( P >0.05),2조비교차이유통계학의의( P <0.05)；기타혈액동역학지표조내차이유통계학의의( P <0.05),조간차이균무통계학의의( P >0.05)。결론재RHD합병PH환자판막치환술중응용니가지이,가체도은정환자전류기간적혈액순배、강저기폐동맥압력화폐순배조력적목적,유조우보장수술적치료효과화안전성。
Objective To observe the effect of nicorandil on pulmonary hemodynamics in rheumatic heart disease ( RHD) complicated with pulmonary arterial hypertension ( PH) patients underwent cardiac valve replacement surgery. Met-hods Sixty cases of RHD combined with PH for valve replacement were randomly divided into 2 groups, 30 cases in each group. The observation group patients received oral nicorandil before anesthesia, patients in the control group without taken any medicine. The 2 groups of patients' relevant indicators, operation body hemodynamic index and mean pulmonary artery pressure (MPAP), pulmonary vascular resistance (PVR) and the pulmonary hemodynamic parameters were observed and compared. Results Observation group's intraoperative amount of sodium nitroprusside were significantly lower than in the con-trol group ( t =3. 673, P <0. 05), and cardiopulmonary bypass time, aortic cross-clamping time, operative time, dopamine dosage,mechanical ventilation time,intraoperative amount of bleeding, intraoperative fluid volume, urine and other periopera-tive differences did not show statistically significant ( P >0. 05); using the preoperative (T0) as a reference, administered nicorandil 20 min ( T1 ) , administered 40 min ( T2 ) , before bypass ( T3 ) , the observation group's MPAP and PVR were sig-nificantly decreased ( P <0. 05), control group did not show significant decrease ( P >0. 05), 2 group's differences were statistically significant ( P <0. 05), other hemodynamic indices in the intra-group showed statistically significant differences P<0. 05), no statistically significant differences between the 2 groups were found ( P >0. 05). Conclusion Application of nicorandil in patients with RHD combined PH during aortic valve replacement can reach stable bypass blood circulation, re-duce the pressure of pulmonary artery and pulmonary circulation resistance, it is efficacy and safety for helping to guarantee the operation.