心先安防治不停跳心内直视手术心律失常的效果和安全性

Meglumine adenosine cyclophosphate in prevention of arrhythmia in on-pump beating-heart intracardiac procedures

目的研究常温不停跳心内直视手术中在进行心内直视手术操作前静脉注射心先安(即环磷腺苷葡胺)预防心律失常的效果和安全性。方法将45例ASAⅢ级行房室瓣置换心内直视手术患者随机分成两组:心先安(H组n=22)和对照组(C组n=23)。在体外循环(C BP)即将开始前,H组经氧合器给药旁路注入心先安90m g;C组注入10%葡萄糖20m L。监察术中病人的心率(H R)、平均动脉压(M A P)、静脉压(C VP),记录心律失常以及脱离C PB后血液流变学指标和血管活性药物应用情况。结果两组在心内直视手术时间、上、下腔静脉阻断时间差异无显著性(P>0.05);H组心律失常的发生率(45.5%)明显低于C组(82.3%),(P<0.05);H组在脱离C PB后血液流变学指标更稳定,血管活性药物用量明显减少(P<0.05)。结论在常温不停跳心内直视手术中,预防性注入心先安可降低心律失常的发生率,并且在脱离C PB后血液流变学指标更稳定,血管活性药物用量和种类明显减少,效果满意,安全可靠。

To investigate whether to infuse a bolus of meglumine adenosine cyclophosphate by way of the oxygenator before starting of CBP could lower the incidence of arrhythmia in on-pump beating-heart intracardiac procedures. 45 patients (ASA statusⅢ) scheduled for heart valve replacement were randomly divided into two groups: Meglumine adenosine cyclophosphate group(group H n =22); control group (group C n =23). 22 patients in group H received 90 mg of Meglumine adenosine cyclophosphate before starting of CBP, and 23 patients in group C received 10 mL of Saline. Arrhythmia was monitored by continuous ECG. Blood dynamic indexes were monitored by HR, MAP, CVP, and the situations of heart beating were observed by surgeons. The incidence of arrhythmia in group H was much lower than it in group C (P<0.05). Comparing with group C, the blood dynamic indexes of group H after CBP was more stable. [Conclusions] Infusing a bolus of Meglumine adenosine cyclophosphate by way of the oxygenator before starting of CBP can lower the incidence of arrhythmia in on-pump beating-heart intracardiac procedures and is related with better blood dynamic indexes after CBP.