瓣膜置换术患者心肺转流后多巴酚丁胺与米力农对心肌应变力的影响

Effects of dobutamine with those of milrinone on myocardial strain in patients undergoing valve replacement surgery

目的探讨瓣膜置换术后早期多巴酚丁胺与米力农对心肌应变力的影响。方法择期心肺转流(CPB)下行瓣膜置换术患者55例,男27例,女28例,年龄40～75岁,ASAⅡ或Ⅲ级,NYHA心功能Ⅱ或Ⅲ级。采用随机数字表法将患者分为三组:多巴酚丁胺组(D组,n=18)、米力农组(M组,n=20)和对照组(C组,n=17)。三组术中麻醉维持均采用全凭静脉麻醉,D组于停CPB15min后经微量注射泵静注多巴酚丁胺4μg·kg^(-1)·min^(-1)至1h结束,M组于同一时点开始经微量注射泵静注米力农0.4μg·kg^(-1)·min^(-1)至1h结束,C组于同一时点开始经微量注射泵静注等量生理盐水至1h结束。分别于麻醉诱导后劈胸骨前(T0)和停CPB后15min(T1)、泵药后30min(T2)和1h(T3)记录血流动力学指标:HR、CVP、CO、LVEF、右室面积变化分数(RVFAC)、心脏指数(CI)、外周血管阻力指数(SVRI)和应变力参数:左室长轴全局纵向应变力(S-LVL)、左室短轴全局环向应变力(S-LVM)和右室长轴全局纵向应变力(S-RV)。结果 T2、T3时D组HR明显快于M组,T3时D组HR明显快于C组(P<0.05);T2时D组CI明显高于C组和M组(P<0.05)。T2、T3时D组和M组左室短轴环向应变力S-LVM明显高于C组(P<0.05);T3时D组S-LVL与M组S-RV明显高于C组(P<0.05)。结论 CPB后静脉输注小剂量多巴酚丁胺能够改善S-LVL与S-RV,米力农有助于增加S-LVm与S-RV。

Objective To compare the effects of dobutamine with those milrinone on myocardial strain in patients undergoing valve replacement surgery.Methods Fifty-five patients udergoing valve replacement surgery,27 males and 28 females,aged 40-75 years,falling into ASA physical statusⅡorⅢ,New York Heart Association(NYHA)ⅡorⅢ,were included in this study.They were divided into 3 groups by using a random number table:intravenous infusion dobutamine group(group D,n=18),intravenous infusion milrinone group(group M,n=20)and intravenous infusion saline group(group C,n=17).All patients were used general anesthesia.In groups D,the patients received intravenous infusion dobutamine(4μg·kg^-1·min^-1)for an hour starting from 15 min after termination of CPB.In group M,the patients did intravenous infusion milrinone(0.4μg·kg^-1·min^-1)in the same way.In group C,the patients got intravenous infusion saline also.After induction of anesthesia,these patients were recorded for hemodynamic measurement at three points after induction of anesthesia and before splitting of sternum(T0),starting from 15 min after termination of CPB(T1),intravenous infusion medicine for 30 min(T2),intravenous infusion medicine for one hour(T3):HR,CVP,cardiac output(CO),left ventricular ejection fraction(LVEF),right ventricular fractional area change(RVFAC),cardiac index(CI)and systemic vascular resistance index(SVRI)and strained indicator:global longitudinal strain of left ventricle(S-LVL),global circumferential strain of the left ventricle(S-LVM),global longitudinal strain of right ventricle(S-RV).Results Compared with group M,HR in group D at T2 and T3 was higher(P<0.05).Compared with group C,HR in group D at T3 was higher(P<0.05).And CI in group D at T2 was higher than that in groups C and M(P<0.05).Compared with groups C,S-LVM in groups D and M at T2 and T3 were stronger,S-LVL,S-RV in group D and S-RV in group M at T3 were stronger(P<0.05).Conclusion Intravenous infusion dobutamine can improve S-LVM,S-LVL and S-RV;Intravenous infusion milrinone can improve S-LVM and S-RV.