新斯的明复合美托洛尔在不停跳冠状动脉搭桥术中控制心率的应用研究

EFFECT OF NEOSTIGMINE COMBINED METOPROLOL FOR CONTROLLING HEART RATE IN OFF-PUMP CORONARY ARTERY BYPASS GRAFTING

目的探讨新斯的明复合美托洛尔在非体外循环冠状动脉旁路移植术中控制心率的疗效及安全性。方法 14例冠心病患者,ASAⅡ~Ⅲ级,采用气管插管静吸复合全麻,术中行有创动脉血压、心电图、脉搏氧饱和度、呼气末二氧化碳分压、心排血量、体循环阻力、肺动脉压力、肺毛细血管楔压、尿量、肛温监测。手术方式均为非体外循环下行冠状动脉旁路移植术。术中心率〉90次/min时,在确保一定的麻醉深度及容量负荷的前提下静注美托洛尔6~10mg后效果不佳者,给予少量新斯的明（0.2~0.4mg）。结果 10例患者使用新斯的明0.2mg后心率减少慢8~15次/min,其余4例患者静注新斯的明0.2mg后减慢心率作用不明显,加用0.1~0.2mg后心率减慢13~28次/min。本组患者术后恢复顺利,10例术后4~7h拔除气管导管,4例术后7~24h拔除气管导管。结论在不停跳冠状动脉搭桥术过程中,心率较快且难控制时,在保证一定麻醉深度及容量负荷的前提下,使用较大剂量美托洛尔效果欠佳时,复合使用小剂量新斯的明控制心率是安全有效的。

Objective To observe the effect of neostigmine combined metoprolol for controlling heart rate in off-pump coronary artery bypass grafting.Methods 14 ASAⅡ~Ⅲ patients with coronary heart disease,scheduled off-pump coronary artery bypass grafting with inhalation and intravenous general anesthesia.ABP,ECG,SpO2,PETCO2,CO,systemic vascular resistance,PAP,PAWP,rinary production and rectal temperature were monitored in the operations.When heart rate exceeded 90 bpm,if effect was not good after intravenous injection of metoprolol（6~10mg）,neostigmine（0.2~0.4mg） were injected.Results The heart rate decreased 8~15bpm after iv injection of neostigmine 0.2mg in 10 patients and 13~28 bpm with neostigmine 0.3mg in the other 4 patients.All patients recovered smoothly.10 patients were extubated after operation 4-7h,4 patients after 7-24h.Conclusion Low dose neostigmine controlling heart rate is feasible after ineffective with βreceptor blockage in off-pump coronary artery bypass grafting.