米力农用于体外循环心脏瓣膜置换术后对心肌应变力的影响

Effect of Milrinone on Myocardial Strain After Cardiac Valve Replacement with Cardiopulmonary Bypass

目的:研究米力农用于体外循环(CPB)心脏瓣膜置换术后对心肌应变力的影响。方法:纳入2019年3月~2020年3月本院收治的74例择期拟行CPB心脏瓣膜置换术患者为研究对象,按照随机数字表法分为观察组和对照组,每组37例。两组术中均采用静脉麻醉,其中观察组术中采用米力农经微量注射泵静脉注射,对照组于同一时点静脉注射等容量生理盐水。分别于麻醉后劈胸骨前(T_(0))、CPB停机15 min后泵药前(T_(1))、米力农或生理盐水输注30 min(T_(2))和1 h(T_(3))时记录左心室短轴全局环向应变力(S-LV_(M))、左心室长轴全局纵向应变力(S-LV L)、右心室长轴全局纵向应变力(S-RV)及心肌肌钙蛋白1(cTN1)、肌酸激酶同工酶(CK-MB)水平,分析心率(HR)、中心静脉压(CVP)、心脏指数(CI)变化情况。结果:观察组T_(2)和T_(3)时S-LV_(M)高于对照组(P<0.05);T_(1)和T_(3)时S-RV高于对照组(P<0.05)。两组T_(1)、T_(2)和T_(3)时cTN1和CK-MB高于T_(0)时,且呈上升趋势(P<0.05);观察组T_(1)、T_(2)、T_(3)时cTN1和CK-MB低于对照组(P<0.05)。两组T_(1)、T_(2)和T_(3)时HR、CI和CVP水平均高于T_(0)时(P<0.05)。结论:米力农可有效增强CPB心脏瓣膜置换患者术后心肌应变力,改善心功能。

Objective:To study the effect of milrinone applied in cardiopulmonary bypass(CPB)on myocardial strain.Methods:74 patients scheduled for CPB cardiac valve replacement in our hospital from March 2019 to March 2020 were included.They were randomly divided into observation group and control group,37 cases in each group.Intravenous anesthesia was used in both groups.Milrinone was injected intravenously in the observation group,and the same volume of normal saline was injected intravenously in the control group at the same time point.The global eircumferential strain of left ventricle(S-LV M),global longitudinal strain of left ventricle(S-LV_(L)),global longitudinal strain of right ventricle(S-RV),cardiac troponin 1(cTN1)and creatine kinase isoenzyme-MB(CK-MB)were recorded before sternotomy(T_(0)),15 min after CPB shutdown(T_(1)),30 min(T_(2))and 1 h(T_(3)).The changes of heart rate(HR),central venous pressure(CVP)and cardiac index(CI)were analyzed.Results:In observation group,S-LV_(M) at T_(2) and T_(3) was higher than that of control group(P<0.05);S-RV at T_(1) and T_(3) was higher than that of control group(P<0.05).In both groups,cTN1 and CK-MB at T_(1),T_(2) and T_(3) were higher than at T_(0) with a significant upward trend(P<0.05).cTN1 and CK-MB of T_(1),T_(2) and T_(3) in the observation group were significantly lower than those in the control group(P<0.05).The HR,CI and CVP levels at T_(1),T_(2) and T_(3) in both groups were higher than those at T_(0)(P<0.05).Conclusion:Milrinone can effectively enhance myocardial strain and improve cardiac function in patients with CPB heart valve replacement.