去甲肾上腺素在成人心脏手术后的早期应用

Application of norepinephrine in patients early after cardiac surgery

目的探讨去甲肾上腺素在体外循环心脏手术后的早期应用对循环、肾脏功能方面的影响。方法选择2008年1月～2010年6月成人心脏手术后早期应用去甲肾上腺素的病例43例,临床表现为容量依赖,常有短时尿量多,和(或)引流液多,末梢温暖,但积极补充血容量,循环仍难维持等情况,应用去甲肾上腺素前后对心率、平均动脉血压、中心静脉压、尿量、血清肌酐值等方面进行比较。结果应用后心率较应用前有显著性下降(P<0.01),应用后血压较前有显著性升高(P<0.01),中心静脉压和平均每小时尿量在应用前后均无显著性变化(P=0.437>0.05;P=0.063>0.05),血清肌酐浓度在应用去甲肾上腺素后较前有显著性升高(P<0.01),但无一例出现急性肾功能衰竭。结论在成人心脏手术后早期出现血管扩张性(或麻痹性)休克,应用去甲肾上腺索能支持循环功能,保证肾灌注,是可行和安全的。

Objective To research the effect of norepinephrine on circulation and renal functions in patients early after cardiac surgery. Methods 43 patients were enrolled, with application of norepinephrine in patients early after cardiac surgery from January of 2008 to June of 2010. Under those clinical manifestation which were volume dependence, often polyu- ria in a short time after cardiac surgeries with or without large number of drainage, warm periphery, difficultly maintaining circulations though volumes were made - up actively, and so on. Heart rate, mean arterial blood pressure, center venous pressure, urinary volume per hours, and serum creatinine patients before application of norepinephrine were compared with that after application of norepinephrlne. Results Compared with five porters before application of norepinephrine, norepinephrine heart rate was decreased after application（ P 〈 0. 01 ） , mean arterial blood pressure was increased （P 〈 0.01 ）, center venous pressure and urinary volume per hours have no statistical difference （P =0. 437 〉0.05 ;P =0. 063 〉0. 05）, and serum creatinine was higher （ P 〈 0. 01 ） but no case of acute renal failure. Conclusion Norepinephrine supported circulation function and ensured renal per＇fusion in vasodilatory shock early after cardiac surgery. So application of norepinephrine was feasible and safe.