丙泊酚对体外循环期间血浆内皮素及心钠素的影响

The effects of propofol on endothelin and atrial natriuretic polypeptide during Cardiopulmonary Bypass

目的了解不同剂量丙泊酚对体外循环期间血浆内皮素及心钠素的影响。方法20例风湿性心脏瓣膜病患者,随机分为两组,体外循环期间以全凭丙泊酚(>6 mgkg.h-1)控制血压组(P)和丙泊酚(4 mg/kg.h-1)加尼卡地平控制血压组(N),各10例,两组体外循环前后麻醉用药相同;监测指标:分别于入室建立有创动脉压监测后(T1)、体外循环前(T2)、体外循环30min(T3)、停体外循环10min(T4)记录各时点的平均动脉压(MAP),同时采集动脉血2ml,检测各时点血浆内皮素(ET)、心钠素(ANP)。结果两组各时点血流动力学指标无统计学意义;两组间各时间点的ET、ANP浓度组间比较无统计学意义;组内比较:ET水平在T3、T4时显著升高,与T1、T2相比有统计学意义;ANP浓度各时间点相比均无统计学意义。结论体外循环期间单纯应用丙泊酚与小剂量丙泊酚加尼卡地平均可维持血压平稳,对应急激素内皮素及心钠素的影响无明显差异。

Objective To explore the effects on endothelin and atria natriuretic polypeptide during Cardiopulmonary Bypass by using different doses of propofol. Methods 20 patients with rheumatic valvular disease of the heart were randomly assigned to two groups ： in group P （ n = 10）, the mean blood pressure （MAP） was controlled by adjusting propofol infusion rate （6 - 10 mg/kg/h） ; in group N （n = 10）, the mean blood pressure was controlled by propofol infusion rate of 4mg/kg/h and adjusting nicardipine infusion rate. The MAP was recorded before induction （ T1 ）, before cardiopulmonary bypass （T2 ）, 30 min after cardiopulmonary bypass （T3 ） and 10 rain after cardiopulmonary bypass stopping （ T4 ）. Blood samples （2ml） were taken at T1, T2, T3 and T4 for determining endothelin （ET）, atrial natriuretic polypeptide （ANP）. Results （1） The results showed no significant difference in MAP at T1 between two groups. （2） There were no significant difference in ET and ANP plasma concentration at T1 , T2, T3 and T4 between two groups. The plasma concentration of ET at T3 and T4 were significant higher than those at T1 and T2 （P 〈 0.05 ）. There were no significant difference in ANP plasma concentration at T1, T2 , T3 and T4. Conclusion It can keep the stability of hemodynamics by using propofol or propofol and nicardipine infusion during cardiopulmonary bypass. There were no significant difference in inhibitory action of endothelin and atrial natriuretic polypeptide.