不同术前药的冠心病病人术中冠脉搭桥前入液量对血流动力学的影响

The Influence of Liquid Intake via Intravenous on the Hemodynamics of Patients Undergoing Coronary Artery Graft with Different Premedicants

将 8 0例冠脉搭桥病人随机双盲分为 :A组 (对照组 ,n =4 0 ) ;B组 (试验组 ,n =4 0 )。A组术前 1h口服安定 10mg、术前 30min肌注吗啡 0 .15～ 0 .2mg/kg和东莨菪碱 0 .3mg。B组术前药增加口服氨酰心安6.2 5～ 12 .5mg及硫氮唑酮 30mg。分别观察体外循环 (CPB)前 2组病人在不同入液量下的各项血流动力学指标。A组与B组病人诱导后静脉入液量分别为 652 .5ml及 657.5ml;开胸前分别为 1116.3ml及 10 70 .0ml,明显高于诱导后静脉入液量 (P <0 .0 1) ;CPB前分别为 1711.3ml及 1715.0ml,显著高于诱导后和开胸前的静脉入液量 (P <0 .0 1)。与麻醉诱导后比较 ,开胸前A组与B组病人的各项血流动力学参数均无显著差异(P >0 .0 5)。与麻醉诱导后和开胸前比较 ,CPB前A组病人SBP明显下降 (P <0 .0 5和P <0 .0 1) ;DBP明显降低 (P <0 .0 1) ;MAP明显低于开胸前 (P <0 .0 1) ;HR明显高于诱导后 (P <0 .0 5) ;CO及CI明显增高 (P <0 .0 5) ;SVR及SVRI明显降低 (P <0 .0 1)。CPB前B组病人SBP明显低于开胸前 (P <0 .0 1) ;DBP明显降低(P <0 .0 5和P <0 .0 1) ;MAP明显下降 (P <0 .0 5和P <0 .0 1) ;HR明显高于诱导后 (P <0 .0 1) ;SVR及SVRI明显降低 (P <0 .0 5)。当入液量增加到一定量时 ,SVR及SVRI明显降低、血压下降、HR?

To study the influence of liquid intake via intravenous before coronary artery graft on the hemodynamics of patients with different premedicants.Eighty patients undergoing coronary artery graft were randomly divided into two groups:In group A,oral diazepam 10 mg,morphine 0.15～0.2 mg/kg IM and scopolamine 0.3 mg IM as premedicants.In group B,oral diazepam 10 mg,atenolol 6.25～12.5 mg and diltiazem 30 mg,morphine 0.15～0.2 mg/kg IM and scopolamine 0.3 mg IM as premedicants.The hemodynamics were measured after intubation,before opening chest and before cardiopulmonary bypass(CPB) in group A and group B.The liquid intake via IV were 652.5 ml and 657.5 ml after intubation respectively in group A and group B.Before opening chest,the liquid intake via IV were 1116.3 ml and 1070.0 ml respectively in group A and group B,It were significantly different from the liquid intake via IV after intubation ( P < 0.01). Before CPB,the liquid intake via IV were significant higher in group A(1711.3 ml, P < 0.01) and in group B(1715.0 ml, P <0.01)than the liquid intake of after intubation.Before opening chest,there were no significant different on hemodynamics from after intubation in group A and group B( P >0.05).In group A,before CPB the SBP was lower than after intubation( P <0.05)and before opening chest ( P < 0.01 ).Compared with after intubation and before opening chest the DPB,SVR and SVRI were significant low( P <0.01).The MAP were significant lower than before opening chest( P < 0.01). The HR was higher than after intubation( P <0.05).The CO and CI were significant higher than after intubation and before opening chest( P <0.05).In group B,before CPB the SBP was significant lower than before opening chest( P < 0.01). The DBP and MAP were lower compared with after intubation( P <0.05) and before opening chest( P < 0.01). The HR was significant higher than after intubation ( P <0.01).Compared with after intubation and before opening chest,the SVR and SVRI decreased significantly at before CPB( P <0.05).When the liquid intake was enough,the BP,SVR and SVRI decreased significantly.The HR,CO and CI increased significantly.The change of hemodynamics at different liquid intake was no different in group A and group B.