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Objective To investigate whether the supplement of creatine phosphate sodium and tranexamic acid to cardioplegic solutions can improve myocardial protection and blood conservation in off-pump coronary artery bypass graft(OPCABG).Methods 280 patients undergoing OPCABG were randomly assigned to experimental group (CP with TA group, n=70 ) , creatine phosphate sodium group (CP group, n=70), tranexamic acid group (TA group, n=70) and control group (n=70). Before BACG,creatine phosphate sodium ( 100 mg/kg) combined with tranexamic acid (30 mg/kg), creatine phosphate sodium ( 100 mg/kg),tranexamic acid (30 mg/kg), and equal volume of normal saline were given intravenously in each group respectively. Venous blood samples were taken preoperatively, and at 0, 6, 12, 24, 48, 72 h, 7 d postoperatively to analyze creatine kinase isoenzyme (CK-MB), troponin (cTnI) ; Meanwhile, the amount of cumulative chest fluid drainage and inotropic agent and blood transfused were also recorded. Results The plasma concentrations of CK-MB in experimental group at 6, 12, 24, 48, 72 h postoperatively (15±6), (14±5), (16±10), (15±6) and (13±6) U/ml and the plasma concentrations of cTnI(235±1.53), (2.72±1.46), (2.64±1.32),(1.16±0.76) and (0.48±0.24) mg/L were significantly lower than those in group CP, group TA and control group (P<0.05). The amount of postoperative cumulative chest fluid at 6, 12, 24, 48, 72 h were (246±56), (420±82), (680±114), (725±126) and (730±130) ml drainage and blood transfuison in experimental group (5/70) were also significantly lower than those in other groups (P<0.05). Conclusion For patients undergoing OPCABG, creatine phosphate sodium combined with tranexamic acid plays an important role in myocardial protection and blood conservation without increasing the surgical mortality and the incidence of postoperative complications. 相似文献
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肝素应用于临床已46年。我们在体外循环心内直视手术中,应用肝素全身抗凝,和使用鱼精蛋白拮抗肝素,发现一些病人血液动力学有不同程度的变化,为了排除麻醉、剖胸、失血及手术的干扰,以及机械呼吸、输液量和其它药物等因素的影响,特进行动物试验,观察肝素和鱼精蛋白对中心静脉压(CVP)和平均动脉压(MAP)的影响。材料、方法和结果健康雄性杂种家犬20只,随意分为肝素一鱼精蛋自组10只,平均体重为12.33±2.0kg;鱼情蛋白A组5只、B组5只,平均体重为11.6±2.28kg。腹腔内注射硫喷妥钠35mg/kg,然后作股动、静脉切开置管,静脉管插至下腔静脉接 相似文献
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卿恩明 《国际麻醉学与复苏杂志》1995,(2)
体外循环用于心肺复苏,是一个有力的复苏手段,它能有效改善心跳骤停病人生命器官的灌注,使心肺脑复苏(CPCR)同步进行。体外循环无疑是高级心脏急救(ACLS)和生命支持的先进救治方法。本文介绍了国内外临床应用经验,并对其基本方法、适应症进行了探讨。 相似文献
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目的:为减少心脏手术中后中枢神经系统并发症,探讨术中采用连续脑氧饱和度(rSO2)的临床意义。方法:选择2个月-3岁心脏病患儿81例,分为紫绀组(36例)和非紫绀组(45例)。采用芬太尼-安氟醚静吸复合麻醉,体外循环用非搏动平流灌注,流量100-150mL/kg。用脑氧饱和度仪测量rSO2,分别于全麻诱导、主动脉插管、阻断升主动脉、阻断升主动脉后15min,开放升主动脉、停机及手术结束等时点记录rSO2、平均动脉压、鼻温及肛温等变化。结果:麻醉诱导时rSO2平均值46.33%,紫绀组rSO2明显低于非紫绀组;降温阶段,rSO2显著升高,而复 复温开始后rSO2降低,开放升主动脉时达手术过程中最低值(40.69%)。结论:rSO2能较 准确反映此类手术中脑氧合状态。降温阶段rSO2较高不宜过度灌注,复温阶段特别是在开放升主动脉时,rSO2较低,故应避免复温过快,并适时增加流量,适当提供脑灌注压。 相似文献
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先天性心脏病非心脏手术的麻醉处理 总被引:1,自引:0,他引:1
先天性心脏病非心脏手术的麻醉处理于钦军,邓硕曾在美国生存的出生婴儿中,大约有1%患有各种不同类型的先天性心脏病(CHD),在北美CHD发病率持续保持在8‰,现在有近50万CHD病人达到成年,每年至少有2万人做各种不同的修补手术[1]。据雷贞武等[2]... 相似文献
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多培沙明是近年新合成的儿茶酚胺类药,具有显著的节后DA受体和β_2受体激动效应,对β_1受体作用轻微,无α受体活性.它降低心脏负荷,增加心排血量,改善肾脏血流,治疗心力衰竭和用于心脏手术较多巴胺为优.本文对其药理特点和临床应用作了综述. 相似文献
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体外循环后皮肤微循环自律运动的变化龙村,齐文安,胡小琴,张坚,顾烈东微循环自律性运动是一种自发的、与心跳、呼吸无关的节律性运动,是组织血流调节的重要因素。由于各种因素限制,其在心脏直视手术围术期的研究甚少。我们用激光多普勒微循环仪对体外循环(CPB)... 相似文献