1、6二磷酸果糖对重症心血管手术病人围体外循环期血乳酸的影响

目的观察应用1、6二磷酸果糖(fructose-1,6-diphosphete,FDP)可否降低血乳酸水平并改善病人血流动力学及加速病人术后康复的情况。方法行择期冠脉搭桥术、Bentall手术、单纯升主动脉置换或同时瓣膜置换术的成年病人41例:随机分为果糖组(22例)及对照组(19例)。果糖组分别在转机前及转机40 min于体外循环(cardiopulmonary bypass,CPB)预充液中加入FDP,于麻醉诱导后、心肌血流阻断15min、转流80min、停机前、鱼精蛋白中和后、入ICU后即刻及术后第1天晨取动脉血查血气分析及乳酸浓度,同时观测并记录动脉血压、心率、正性肌力药物用量、CPB时间、心肌血流阻断时间、术后机械通气时间I、CU滞留时间及术后住院时间。结果两组患者年龄、体重、主动脉阻断时间、转流时间、术后机械通气时间、入住ICU时间、术后住院时间均无显著性差异(P0.05)。除转流80min和停机后果糖组心率低于对照组(P0.05)及阻断15min果糖组硝酸甘油用量低于对照组(P0.05)之外,两组患者各时点血压、心率、变力性药物用量均无显著性差异(P0.05)。两组内各时点血乳酸均较麻醉诱导后的数值显著性提高(P0.05),两组间患者各时点血乳酸均无显著性差异(P0.05)。结论将10gFDP分次加入预充液中不能降低CPB中、后的血乳酸水平并明显改善病人血流动力学及预后。

The Influence of Fructose-1, 6-diphosphete on Blood Lactate Concentrations in Patients Undergoing Cardiopulmonary Bypass

Objective To evaluate the influence of fructose-1,6-diphosphete（FDP） on blood lactate,haemodynamics and prognosis in critical patients undergoing cardiopulmonary bypass（CPB）.Methods 41 patients undergoing coronary artery bypass grafting,Bentall operations and cardiac valve replacement were randomly divided into FDP group（n=22） and control group（n=19）.In FDP group,5 g FDP were added into the priming solution before CPB and 40 min after start of CPB,respectively.Blood lactate concentrations and arterial blood gas analysis were measured during perioperative period.Mean arterial pressure,heart rate,inotropic drug dosage,CPB parameters and clinical outcomes were observed at the same time.Results There was no significant difference between two groups in parameters concerning preoperative clinical,haemodynamics,inotropic drug dosage,CPB and outcome（P〉0.05）,and perioperative blood lactate concentrations（P〉0.05）.Patients had similar blood lactate concentrations between two groups including all datas（P〉0.05） and both groups had higher blood lactate concentrations during and after CPB than that after induction（P〈0.05）.Conclusion Prime with 10 g FDP during CPB did not show benefit on reducing patients＇perioperative blood lactate concentrations and improving haemodynamics and prognosis.