压宁定对心脏手术围术期患者血流动力学影响的研究

Hemodynamic effects of urapidil in patients during perioperative period of cardiac surgery

目的 :通过监测压宁定对心脏外科患者术后血流动力学指标的变化 ,研究其对患者血流动力学的影响。 方法 :2 2例先天性心脏病房间隔缺损 (ASD)、室间隔缺损 (VSD)和风湿性心脏病换瓣等患者 ,麻醉后放置 7F右心 Swan- Ganz飘浮导管 ,测血流动力学参数后分为肺动脉高压 (PAH )组 12例和非肺动脉高压 (NPAH )组 10例。术后根据患者循环情况用血管活性等药物 ,1h后停用硝普那 (SNP) ,45 min后静推压宁定 0 .5 mg/ kg,然后 2～ 4μg· kg- 1 · m in- 1 静脉维持。测量压宁定用药前、用药后 30、45、6 0、75 m in时血流动力学指标。 结果 :PAH组用压宁定后肺血管阻力 (PVR)、肺动脉血压 (PAP)明显下降 (P <0 .0 5～ 0 .0 1) ,心指数 (CI)及搏指数 (SI)明显增加 (P <0 .0 5～ 0 .0 1)。 PAH组压宁定对肺循环的扩张作用明显大于体循环 ,在扩血管的同时心率变化不明显。NPAH组压宁定对体循环和肺循环的扩血管作用相差不大。结论 :压宁定作为强效血管扩张剂应用于心脏外科围术期 ,对 PAH病人的肺循环影响大于体循环 ,并且不增加心率 ,有益于 PAH患者或心肌损害和缺血病人的使用。

Objective: Hemodynamic effects of urapidil was investigated in patients with pulmonary arterial hypertension during preoperative period of cardiac surgery. Methods: Twenty two patients with congenital heart atrial septal disease (ASD), ventricular septal disease (VSD) and heart valvular diseases were laid by. Swan Ganz catheterization in pulmonary artery via right external jugular vein after general anaesthesia. Patients were divided into pulmonary arterial hypertension group (12 cases) and normal pulmonary arterial pressure group (10 cases) according to pulmonary arterial pressure. Vasoactive drugs and vasodilator (sodium nitroprusside) were used to patients according to circulation into cardiopulmonary bypass and thereafter vasodilator was stopped at 1 hour postoperatively. Hemodynamic parameters were measured at period of discontinuation of vasodilator for 45 minutes. Urapidil was injected into vein (0.5 mg/kg). afterward, dose of urapidil was maintained in 2~4 μg·kg -1 ·min -1 accorting to patient's blood pressure et al. Hemodynamic data were measured at 30、45、60、75 min after using urapidil. Result: Pulmonary arterial pressure (PAP) and pulmonary vascular resistance decreased significantly (P<0.01) in pulmonary hypertensive group, caidiac index (CI) and stroke index (SI) showed increase (P<0.05), Heart rate reduced evidently, while vasodilator and pulmonary circulatory effects with urapidil were as strong as systemic circulation; pulmonary and systemic circulatory pressure resistance demonstrated to be decreased and showed similar tendency in contrast group. Conclusion: Urapidil can be used in perioperative period of cardiac surgery as a strong vasodilator drug that can reduce pulmonary arterial hypertension and improve cardiac function evidently; it shows some special advantages such as no reflex tachycardia and reduce myocardiac oxygen consumption etc.