咪唑安定在瓣膜置换术麻醉诱导期间对血流动力学的影响

THE EFFECT OF MIDAZOLAM INDUCTION ON HEMODYNAMICS IN PATIENTS UNDERGOING CARDIAC VALVE REPLACEMENT

目的：观察咪达唑仑（咪唑安定）对心脏瓣膜置换术患者血流动力学的影响。方法：静注０２ｍｇ／ｋｇ咪唑安定进行诱导，局麻下插ＳｗａｎＧａｎｚ导管到肺动脉测血流动力学变化，用热稀释法测ＣＯ。结果：收缩压（ＳＰ）、舒张压（ＤＰ）、平均动脉压（ＭＡＰ）、心输出量（ＣＯ）、心指数（ＣＩ）、平均肺动脉压（ｍＰＡＰ）、肺动脉楔压（ＰＡＷＰ）和右室每搏功（ＲＶＳＷ）在给药后１０ｍｉｎ明显下降，对左室每搏功（ＬＶＳＷ）、全身血管阻力指数（ＳＶＲＩ）和心率（ＨＲ）无明显影响，气管插管和劈胸骨时，ＳＰ、ＤＰ、ＭＡＰ上升到给药前值，但ＣＯ、ＣＩ、每搏量（ＳＶ）、ｍＰＡＰ、ＰＡＷＰ仍有显著差异，术毕ＳＰ、ＤＰ、ＭＡＰ、ＣＯ、ＣＩ、ｍＰＡＰ和ＰＡＷＰ均明显低于诱导前值。结论：咪唑安定对心功能差的患者有一定的心肌抑制作用，但尚平稳，且能降低ｍＰＡＰ、ＰＡＷＰ，故尚能安全地用于心脏瓣膜置换术患者的诱导。

Objective: The hemodynamic effects during anesthetic inductions with 0 2 mg/kg midazolam was studied in 10 patients scheduled for cardiac valve replacement. Method: Patients were administrated intravenous midazolam 0 2 mg/kg, 7F Swan Ganz catheter was inserted into the pulmonary artery via the right internal jugular vein, CO was measured with the thermodilution method. Results: SP,DP,MAP,CO,CI,mPAP,PAWP and RVSW were significantly decreased 10 min after midazolam administration and SP,DP,MAP increased during intubation and after sternotomy while CO,CI,SV,mPAP,PAWP remained lower. SP,DP,MAP,CO,CI,mPAP and PAWP were decreased than that before induction. Conclusion: Midazolam may be administrated safely for patients undergoing cardiac valve replacement.