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目的:探讨不同剂量丹参酮ⅡA对非体外循环冠状动脉旁路移植术患者血流动力学的影响。方法:选择2016年11月-2017年4月择期行非体外循环冠状动脉旁路移植术患者66例,按随机数字表法分为对照组(33例)和观察组(33例)。两组患者于手术开始时静脉滴注丹参酮ⅡA磺酸钠注射液负荷剂量0.4 μg/kg,持续时间10 min;然后对照组患者调整剂量为0.2 μg/(kg·h)至术毕,观察组患者调整剂量为0.4 μg/(kg·h)至术毕。观察两组患者麻醉诱导前(T0)、气管插管后5 min (T1)、胸骨锯开时(T2)、前降支吻合结束时(T3)、右冠状动脉吻合结束时(T4)、术毕时(T5)时的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、平均肺动脉压(MPAP)、肺毛细血管楔压(PCWP)、心脏指数(CI)、体循环阻力指数(SVRI)、肺循环阻力指数(PVRI)及不良反应发生情况。结果:T0时,两组患者HR、MAP、CVP、MPAP、PCWP、CI、SVRI、PVRI比较,差异均无统计学意义(P>0.05)。 T1~T5时,对照组患者HR、MAP、CVP、MPAP、PCWP、SVRI、PVRI均显著高于同组T0时,差异均有统计学意义(P<0.05),但对照组 T1~T5之间比较、T1~T5时CI与T0时比较及观察组患者 T1~T5时的HR、MAP、CVP、MPAP、PCWP、SVRI、PVRI与同组T0时比较,差异均无统计学意义(P>0.05)。T1~T5时,观察组患者CI均显著高于同组T0时及对照组,HR、MAP、CVP、MPAP、PCWP、SVRI、PVRI均显著低于对照组,差异均有统计学意义(P<0.05)。两组患者用药期间均未见明显不良反应发生。结论: 0.4 μg/(kg·h)丹参酮ⅡA有助于稳定非体外循环冠状动脉旁路移植术患者的血流动力学,提高心功能,且安全性较好。
OBJECTIVE: To investigate the effects of different doses of tanshinone ⅡA on hemodynamics in patients underwent non-extracorporeal circulation coronary artery bypass grafting (NECCABG). METHODS: A total of 66 patients underwent selective NECCABG during Nov. 2016-Apr. 2017 were selected and divided into control group (33 cases) and observation group (33 cases) according to random number tablet. Both groups were given Tanshinone ⅡA sodium sulfonate injection with loading dose of 0.4 μg/kg for 10 min at the beginning of surgery. Control group was given Tanshinone ⅡA sodium sulfonate injection 0.2 μg/(kg·h)continuously till the end of surgery; observation group was given 0.4 μg/(kg·h) continuously till the end of surgery. HR, MAP, central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), systemic vascular resistance index (SVRI), pulmonary circulation resistance index (PVRI) and the occurrence of ADR were observed in 2 groups before anesthesia induction (T0), 5 min after tracheal intubation (T1), at the moment of sternum cut (T2), at the end of anastomosis of anterior descending branch (T3), at the end of anastomosis of right coronary artery (T4), at the end of operation (T5). RESULTS: At T0, there was no statistical significance in HR, MAP, CVP, MPAP, PCWP, CI, SVRI or PVRI between 2 groups (P>0.05). At T1-T5, HR, MAP, CVP, MPAP, PCWP, SVRI and PVRI of control group were significantly higher than at T0, with statistical significance (P<0.05). There was no statistical significance in CI of control group among at T1-T5 and with at T0; there was no statistical significance in HR, MAP, CVP, MPAP, PCWP, SVRI or PVRI of observation group between at T1-T5 with at T0 (P>0.05). At T1-T5, CI of observation group was significantly higher than at T0 and than control group; HR, MAP, CVP, MPAP, PCWP, SVRI and PVRI were significantly lower than control group, with statistical significance (P<0.05). No obvious ADR was found in 2 groups during medication. CONCLUSIONS: Tanshinone ⅡA 0.4 μg/(kg·h) is helpful to keep hemodynamics stable and improve heart function in patients with NECCABG with good safety.
丹参酮ⅡA非体外循环冠状动脉旁路移植术血流动力学影响
Tanshinone ⅡANon-extracorporeal circulation coronary artery bypass graftingHemodynamicsEffects
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