鱼精蛋白引起的血液动力学的变化

PROTAMINE-INDUCED HEMODYNAMIC CHANGES IN PATIENTS WITH CARDIAC VALVE REPLACEMENT

本文观察了２０例风湿性心脏病患者瓣膜替换术后经升主动脉根部注射鱼精蛋白所引起的血液动力学变化。根据主动脉阻断时间（ＡＣＣＴ）将患者分成两组：Ｉ组（ｎ＝９），ＡＣＣＴ≥１２０分；Ⅱ组（ｎ＝１１），ＡＣＣＴ＜１２０分。结果显示：注射鱼精蛋白后，两组的心脏指数、每搏指数、左右心脏作功指数、左右心室每搏作功指数均显著下降；平均动脉压（ＭＡＢＰ）均有下降趋势，而以Ｉ组下降更为明显；体循环阻力指数在两组中均有上升趋势，以Ⅱ组的上升有统计学意义。心率、平均肺动脉压、肺动脉楔压无显著变化；ＡＣＣＴ与ＭＡＢＰ下降程度间存在显著的正相关。表明心脏瓣膜替换术后经升主动脉注射鱼精蛋白，可引起血液动力学的改变；且可能是鱼精蛋白对心肌功能的直接抑制所致。ＡＣＣＴ较长的患者，鱼精蛋白引发的低血压更为明显。

The effect of protamine sulfate on the hemodynamics was evaluated in 20 patients with rheumatic heart disease undergoing cardiopulmonary bypass (CPB) for cardiac valve replacement. After the induction of anesthesia, a Swan-Ganz pulmonary catheter (7F, Arrow Company) was inserted via the internal jugular vein for hemodynamic measurements. According to aortic cross-clamping time (ACCT), the patients were divided into two groups: With ACCT≥120 min as group 1 (n=9) and ACCT<120 min as group 2 (n =11). After protamine administration, the significant decreases of cardiac index (CI), stroke index (SI) , left cardiac work index (LCWI), left ventricular stroke work index (LVSWI), right cardiac work index (RCWI) and right ventricular stroke work index (RVSWI) were observed in both groups. Additionally, mean arterial pressure (MABP) decreased in all but only significantly for group 1; while the systemic vascular resistance index (SVRI) just significantly elevated in group 2. Significant changes in heart rate (HR),mean pulmonary arterial pressure (MPAP) , pulmoan ry artery wedge pressure (PAWP) as well as pulmonary vascular resistance index (PVRI) were not observed in either group. There seems to be a correlation between the extent of MABP decrease and the length of ACCT. Our data indicate that the cardiovascular depression induced by protamine administered via the ascending aorta is most likely a result of protamine effect on the ischemic myocardium, with the evidence of more pronounced arterial hypotension in patients with longer ACCT.