去甲肾上腺素等在救治体外循环术后循环功能衰竭患者中的作用

Effectiveness of norepinephrine on patients with circulation function failure following extracorporeal circulation operation

目的:探讨去甲肾上腺素(NE)等强效正性血管活性药物对体外循环术后循环功能衰竭患者的救治作用.方法:体外循环术后循环功能衰竭患者19例,在床旁心电、呼吸、有创血压、CVP监护、呼吸机辅助通气及血流动力学严密监测下,应用肾上腺素(AD)等强效正性血管活性药物进行治疗,其中NE0.02～1.0μg/(kg·min)或间羟胺0.5～5μg/(kg·min),AD0.02～1.0μg/(kg·min),多巴胺(DA)5μg/(kg·min),多巴酚丁胺(DOB)各5μg/(kg·min).血流动力学监测心率(HR)、心排指数(CI)、平均肺动脉压(mPAP)、体循环阻力(SVR)、肺循环阻力(PVR)、中心静脉压(CVP)和平均动脉压(MAP);观察治疗前、后的血流动力学、肌酐(Cr)、尿素氮(Bun)变化以及电解质及酸碱平衡情况,如pH值,HC03-,BE,K+、血氧饱和度(SaO2),同期观察尿量(UV)变化.结果:19例循环衰竭患者血流动力学参数及临床状况明显改善,MAP,SVR显著增加(P<0.01),HR,CVP,CI,PVR,Cr,Bun,酸碱平衡、电解质无明显改变,而UV显著增加(P<0.01).康复17例,死亡2例.结论:NE等强效正性血管活性药物对体外循环术后循环功能衰竭患者有良好的救治作用,应用恰当,对肾功能、酸碱平衡无明显影响,是安全有效的危重患者救治药物.

AIM： To probe the remedy effectiveness of strong positive vasoactive agents on patients with circulation function failure following extracorporeal circulation. METHODS： With the monitor of electrocardiograph, respiration, blood pressure, central venous pressure and the assistance of breathing machine, 19 patients with circulation function failure after extracorporeal circulation operation were treated with norepinephrine and other strong positive vasoactive agents： Norepinephrine （NE） 0.02 - 1.0 μg/（ kg · min） or aramine 0.5 - 5 lag/（ kg · min）, adrenaline （AD） 0.02 - 1.0 μg/（kg, min）, dopamine （DA） 5 μg/（ kg·min） and dobutamine（DOB） 5 μg/（ kg · min）. The hemodynamic parameters including heart rate （HR）, cardiac index （CI）, mean pulmonary artery blood pressure （mPAP）, systemic vascular resistance （ SVR）, pulmonary vascular resistance （PVR） and mean artery blood pressure （MAB） were monitored. BUN, Cr, electrolyte, acid-base balance and urinary volume （UV） were also observed. RESULTS： The hemodynamic parameters and clinical conditions of the 19 patients were improved evidently. MAB, SVR and UV increased significantly but HR, CVP, CI, PVR, BUN, Cr, electrolyte and acid-base balance did not change strikingly. Seventeen cases survived and 2 of the 19 cases died. CONCLUSION： Strong positive vasoactive agents have satisfactory remedy effectiveness on the patients with circulation function failure post extracorporeal circulation and proper administration will not really affect renal function, electrolyte and acid-base balance.