ICU中异丙酚对瓣膜置换病人血流动力学的影响

目的　进一步探索异丙酚对瓣膜置换术后病人血流动力学的影响 ,找到适用于重症监护中心 (ICU)镇静的最佳用药方案。方法　给瓣膜置换术后病人小剂量持续静脉推注异丙酚 ,同时Swan Ganz漂浮导管监测血流动力学指标。结果　达到适当镇静水平 ,异丙酚剂量为每小时 (1.2 5± 0 .71)mg kg ;HR、SVR、PVR、MPAP、PAWP、LVSWI×HR、RVSWI×HR于 30min较用药前下降 (P <0 .0 5 ) ,CI、SI分别由 (2 .40± 0 .2 9)L (m2 ·min)、(2 3.7± 2 .6 )ml (m2 ·b)上升至 (2 .77± 0 .36 )L (m2 ·min)、(2 9.9± 2 .5 )ml (m2 ·b) (P <0 .0 5 )。结论　①在ICU中小剂量持续静脉推注异丙酚可使心脏术后病人达到适当镇静水平 ;②对于风湿性瓣膜病人 ,异丙酚可降低心率、体循环阻力、肺动脉压力 ,减少心脏每分耗氧量 ,明显改善心脏功能

The effect of propofol on the hemodynamics of pat ients after valve replacement in ICU

Objective To study the effect of propofol on the hemodynami cs of patients after valve replacement and to find effective protocol of s edation in ICU. Methods Low-dose propofol was given to patients with valve repla cements for a suitable level of sedation.Hemodynamic status was determined by Swan-Ganz catheter. Results The dose of propofol was (1.25± 0.71)mg/(kg*h). HR,SV R,PVR,MPAP,PAWP LVSWI×HR,RVSWI×HR of propofol group at 30 min had more decrease than before using drugs. CI and SI increased respe ctively from (2.40±0.29)L/(m2*min),(23.7±2.6)ml/(m2*b) to (2.77±0.3 6)L/(m2*min),(29.9±2.5)ml/(m2*b)(P<0.05). Conclusion ①The appropriate sedation can be acquired with the con tinuous intravenous use of middle or litt le dosage propofol after cardiac surgery.②Use of propofol can cause to reduse heart rate, reduse resistent of systemic circulation ,reduse pulmonary arte rial pressure and can improve heart functions.