尼卡地平对非心肺转流冠状动脉旁路移植术患者术中血流动力学和氧代谢的影响

Influence of nicardipine on oxygen metabolism and hemodynamics in patients undergoing off-pump coronary artery bypass graft surgery

目的探讨尼卡地平对非心肺转流冠状动脉搭桥术（off-pump coronary artery bypass grafting,OPCABG）患者术中血流动力学和氧代谢的影响。方法选择拟行OPCABG患者79例,年龄51～68岁,ASAⅢ或Ⅳ级,随机分为两组,近端血管吻合前分别持续泵注尼卡地平0.5μg·kg^-1·h^-1组（N组,n=41）或硝酸甘油0.5μg·kg^-1·h^-1组（G组,n=38）。记录麻醉前（T0）和用药后10min（T1）、30min（T2）、60 min（T3）、90 min（T4）时的氧代谢、血流动力学等指标变化情况,包括SvO2、MAP、PaO2、CO、HR和肺血管阻力（PVR）、体循环血管阻力（SVR）、CI、氧摄取率（ERO2）、乳酸（Lac）等。结果与T0时比较,T3,T4时两组患者氧耗明显降低,Lac浓度明显升高,且N组均明显低于G组（P〈0.05）;T3,T4时G组PaO2、氧供明显降低,ERO2明显升高,N组PaO2、氧供明显高于,ERO2明显低于G组（P〈0.05）。与T0时比较,两组T1～T3时PAP、T1～T4时PVR和SVR均明显降低,T3,T4时CI明显升高（P〈0.05）,且T1～T4时N组PVR和SVR明显低于G组,T4时CI明显高于G组（P〈0.05）。两组患者均顺利完成手术,术后均无严重并发症发生。结论尼卡地平可有效改善OPCABG患者术中氧代谢并维持血流动力学稳定。

Objective To investigate the effects of nicardipine on oxygen metabolism and hemodynamics in patients undergoing off-pump coronary artery bypass graft surgery.Methods Seventynine patients,ASA Ⅲ orⅣ,aged 51-68 years with all genders of coronary heart disease undergoing OPCABG were randomly divided into two groups,group N（n=41）and group G（n=38）.Patients in group N were given continuous infusion of nicardipine 0.5μg·kg^-1·h^-1 and group G were given continuous infusion of nitroglycerin 0.5μg·kg^-1·h^-1 before the proximal anastomosis.The hemodynamics and oxygen metabolism index variation including SvO2,MAP,PaO2,CO,HR,PVR,SVR,CI,ERO2 and Lac were recorded at different time points-before anesthesia（T0）and 10min（T1）,30min（T2）,60min（T3）,90min（T4）after administration of anesthesia.Results Compared with T0,oxygen consumption were significantly lower and Lac were higher at T3,T4 in the two groups,and group N was more lower（P〈0.05）;PaO2 and oxygen supply were decreased and ERO2 were increased significantly at T3,T4 in group G（P〈0.05）.Compared with group G,PaO2 and oxygen supply were increased and ERO2 were decreased significantly at T3,T4 in group N（P〈0.05）.Compared with T0,PAP at T1-T3 and PVR,SVR at T1-T4 were lower and CI at T3,T4 were higher in the two groups（P〈0.05）.Compared with group G,PVR and SVR were decreased at T1-T4 and CI were increased at T4 in group N（P〈0.05）.In all patients who were successfully completed the operation,there were no serious post-operative complications.Conclusion Nicardipine can efficiently improve oxygen metabolism and hemodynamics in patients undergoing OPCABG.