美心力应用于危重心脏直视手术围术期的临床观察

目的　研究危重心脏直视手术围术期应用美心力 (注射用 c AMP)的临床效果。　方法　 40例危重心脏直视手术病人随机分为二组 : 组美心力 3mg/kg,加入注射用水 5 0 ml,于主动脉开放即刻静注 1/3量 ,之后微注泵持续静注至术毕 ; 组不用美心力。测定诱导麻醉后、转流 5 min、复跳 10 m in、停机 10 m in及关胸后 10 min等时点 CO、CI、SV、SVI、SVRI、PVRI、L VSWI、RVSWI、MAP、CVP、MPAP、PCWP。记录心脏自动复跳率、电除颤率、窦性心率恢复率、心律失常发生率、围术期及术后二天 c AMP依赖性正性肌力药应用情况。　结果　 组心脏自动复跳率高于 组 ,电除颤率低于 组 , 组心律失常发生率低于 组 (P均 <0 .0 5 )。 组窦性心率恢复率高于 组 (P<0 .0 1)。各时段 组所需c AMP依赖性正性肌力药物种类、剂量和维持时间均多于 组。两组 CO、CI、SV明显高于术前 ,但 组较 组显著 ,MPAP、PCWP、PVR、SVR较术前降低 (P<0 .0 5 ) , 组与 组相比 ,SVR值差异显著 (P<0 .0 1) ,其他各项差别有统计学意义 ;而 HR、MAP、CVP与诱导麻醉后和转流 5 min时比较无明显变化 (P>0 .0 5 )。　结论　重症心脏直视手术应用美心力具有明显的正性肌力、改善心输出量、减少心肌耗氧量 ,降低肺和外周循环阻力及抗心律失常作

A Clinical Study for cAMP Applied to Critical Patients undergoing Direct Vision Cardiac Surgery

Objective\ To study the clinical efficacy of cAMP application in critically patients operated under cardiopulmonary bypass.\ Methods\ From June 1998 to June 1999,forty patients with critical heart disease were scheduled for direct vision cardiac surgery.\ They were randomly allocated to control(unused cAMP) and medicated groups.\ In medicated group,cAMP 3 mg/kg was added to physiological saline and continuous intravenous injected until operation finished.\ CO,CI,SV,SVI,PVRI,LVSWI,RVSWI,MAP,CVP,MPAP and PCWP were measured after induction,cardiopulmonary bypass five min,hear re beat after ten min,post bypass and thoracicclosure. Heart spontaneous re beat rate,electric defibrillation rate,sinus rhythm recover rate,arrhythmia rate,applied situation of cardiac inotropes depend on cAMP during and tow days post operation were recorded.\ Results\ Heart spontaneous re\|beat rate,sinus rhythm recover rate and kind,dose,last time of cardiac inotropes depend on cAMP in medical group were higher,electric defibrillation rate and arrhythmia rate were lower than those of control.\ In two groups,CO,CI,SV were increased,MPAP,PCWP,PVP,SVP were decreased pre operation,but the degree of change in medicated group was significant compare to control,P<0.05 \ No significant difference was show between two groups except SVR(P<0 05).\ HR,MAP,CVP were not change after induction and cardiopulmonary bypass five minutes,P>0 05.\ Conclusion\ cAMP applied to critical patients undergoing direct vision cardiac surgery is evident effecting on increasing positively cardiac inotropism,improving cardiac output,reducing in myocardial oxygen,pulmonary and system vascular resistance,resisting arrhythmia.