不同剂量盐酸戊乙奎醚对体外循环下瓣膜置换术患者微循环的影响

Effects of different doses of penehyclidine hydrochloride on microcirculation in patients undergoing cardiac valve replacement with cardiopulmonary bypass

目的探讨不同剂量盐酸戊乙奎醚对体外循环下瓣膜置换术患者微循环的影响。方法将从2018年9月-2019年2月郑州大学第二附属医院收治的60名行心脏瓣膜置换术的患者随机分为三组:盐酸戊乙奎醚组1(P1组)、盐酸戊乙奎醚组2(P2组)、对照组(C组)。P1组、P2组和C组在中心静脉置管后分别静脉注射盐酸戊乙奎醚0.05 mg/kg、盐酸戊乙奎醚0.1 mg/kg及等量生理盐水;于诱导后(T1)、体外循环开始转机前(T2)、体外循环开始后1 h(T3)、体外循环停止转机时(T4)、术后4 h(T5)、术后24 h(T6)分别收集血液标本,测量患者的血乳酸(LA)值、静脉血氧饱和度(SvO2)和心肌肌钙蛋白I(cTnI)水平,并将相应时间点的尿量记录下来。结果T1时三组患者的LA、SvO2、cTnI及尿量相比较,差异没有统计学意义(P>0.05)。与T1时间点相比,三组患者的LA、尿量与cTnI在T2~T6时明显增高(P<0.05)。与T1时间点相比,P1组、P2组的SvO2在T2时明显减低(P<0.05),在T4~T6时明显增高(P<0.05)。P1组与P2组相比,不同时间点的LA、SvO2、cTnI及尿量相比较,差异没有统计学意义(P>0.05)。与C组相比,P1组、P2组在T2~T6时,LA及cTnI明显减低(P<0.05),SvO2及尿量明显增高(P<0.05)。结论盐酸戊乙奎醚可以改善瓣膜置换术患者的微循环,剂量上大剂量(0.1 mg·kg)组并不优于小剂量组(0.05 mg·kg)。

Objective To investigate the effects of different doses of penehyclidine hydrochloride on microcirculation in patients undergoing cardiac valve replacement with cardiopulmonary bypass.Methods Patients undergoing cardiac valve replacement with CPB were randomly divided into three groups:penehyclidine hydrochloride group 1(P1,n=20),penehyclidine hydrochloride group 2(P2,n=20),and control group(C,n=20).Group P1,group P2,and group C were given with penehyclidine hydrochloride 0.05 mg·kg,penehyclidine hydrochloride 0.1 mg·kg,and the same amount of normal saline;At various time points,after induction of anesthesia(T1),before the start of CPB(T2),1 h after CPB(T3),when CPB was stopped(T4),4 h after surgery(T5)and 24 h after surgery(T6),arterial blood was collected to detect lactic acid(LA)levels,and central venous blood was collected for venous oxygen saturation(SvO2)and cardiac troponin I(cTnI)levels.And then record the amount of urine at the corresponding time point.Results There were no significant differences in LA,SvO2,cTnI and urine volume between the three groups at T1(P>0.05).The serum LA,cTnI levels and urine volume of the three groups at T2-T6 were significantly higher than those at T1(P<0.05).In groups P1 and P2,the SvO2 at T2 was significantly lower than that at T1(P<0.05)while the SvO2 at T4-T6 was significantly higher than that at T1(P<0.05).There was no significant difference in LA,SvO2,cTnI and urine volume between groups P1 and P2 at different time points(P>0.05).Compared with group C,the serum LA,cTnI levels were significantly decreased in groups P1 and P2(P<0.05),and the SvO2 and urine volume were significantly increased in groups P1 and P2(P<0.05).Conclusion Penehyclidine hydrochloride can improve the microcirculation level in patients undergoing cardiac valve replacement with cardiopulmonary bypass.The high dose(0.1 mg·kg)group is not better than the low dose group(0.05 mg·kg).