冯典; 方开云; 高敏; 刚绍鹏; 何祥; 蒋玲; 刘秀伦; 向道康

doi:10.3760/cma.j.issn.0254-1416.2018.12.006

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• 麻醉并发症 •

尼可地尔对体外循环下心脏瓣膜置换术患者早期预后的影响

中华麻醉学杂志, 2018,38(12) : 1430-1433. DOI: 10.3760/cma.j.issn.0254-1416.2018.12.006

摘要

目的

评价尼可地尔对体外循环下心脏瓣膜置换术患者早期预后的影响。

方法

择期体外循环下心脏瓣膜置换术患者40例，年龄18～64岁，ASA分级Ⅱ或Ⅳ级，NYHA分级Ⅱ或Ⅲ级。采用随机数字表法分为2组(n＝20)：对照组和尼可地尔组。尼可地尔组于麻醉诱导后以10～60 μg·kg^－1·h^－1(3～15 ml/h)速率静脉输注尼可地尔至手术结束。于麻醉诱导前(T₀)、术后6、12、24、48和72 h(T_1-5)和出院(T₆)时采集静脉血样，测定血清cTnI和脑利钠肽(BNP)浓度。记录术前及术后心肌缺血事件或心律失常的发生情况；记录术中心脏复跳时除颤情况、自动复跳情况、复跳时用药情况和复跳后心脏节律；记录术中及术后心血管活性药物的使用情况。记录机械通气时间、ICU停留时间及术后住院时间。

结果

与对照组比较，尼可地尔组T₂及T₃时血清cTnI浓度、T_2-6时血清BNP浓度降低，术中去甲肾上腺素及术后多巴酚丁胺用量减少，机械通气时间和ICU停留时间缩短(P<0.05)，除颤率、自动复跳率、复跳时用药率和复跳后心脏节律、术后住院时间比较差异无统计学意义(P>0.05)。

结论

术中持续输注尼可地尔可减轻体外循环下心脏瓣膜置换术患者心肌损伤，改善早期预后。

引用本文: 冯典, 方开云, 高敏, 等. 尼可地尔对体外循环下心脏瓣膜置换术患者早期预后的影响 [J] . 中华麻醉学杂志, 2018, 38(12) : 1430-1433. DOI: 10.3760/cma.j.issn.0254-1416.2018.12.006.

参考文献导出: Endnote NoteExpress RefWorks NoteFirst 医学文献王

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除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。

体外循环(CBP)下心内直视手术不可避免发生心肌缺血再灌注损伤，影响预后。研究表明，ATP敏感性钾通道开放剂可减轻心肌缺血再灌注损伤^[1]。尼可地尔为线粒体ATP敏感性钾通道开放剂，可通过逆转钙超载，稳定细胞膜，保护线粒体功能，减少氧自由基的产生以及抑制中性粒细胞的聚集^[2,3,4]，防治心肌缺血再灌注损伤^[5]，改善心肌梗死患者预后^[6,7]。尼可地尔是否可改善CBP下心内直视手术患者早期预后尚有待研究。本研究拟评价尼可地尔对CBP下心脏瓣膜置换术患者早期预后的影响。

贡献者信息

冯典

550004　贵阳市，贵州医科大学麻醉学院

方开云

550002　贵阳市，贵州省人民医院麻醉科

高敏

550002　贵阳市，贵州省人民医院麻醉科

刚绍鹏

550002　贵阳市，贵州省人民医院麻醉科

何祥

550002　贵阳市，贵州省人民医院麻醉科

蒋玲

550002　贵阳市，贵州省人民医院麻醉科

刘秀伦

550002　贵阳市，贵州省人民医院心外科

向道康

550002　贵阳市，贵州省人民医院心外科

通信作者

方开云

550002　贵阳市，贵州省人民医院麻醉科

Email：fangkaiyun@sina.cn

关键词

尼可地尔; 心肺转流术; 心脏瓣膜假体植入;

基金项目

贵州省科技计划项目（黔科合基础[2016]1089，黔科合SY字[2012]3107，黔科合支撑[2019]2815）

贵州省人民医院博士基金（GZSYBS [2015]05）

历史

出版日期：2018-12-20

收稿日期：2018-08-10

本文编辑

周晓云

Complication of Anesthesia

Effect of nicorandil on early prognosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass

Dian Feng, Kaiyun Fang, Min Gao, Shaopeng Gang, Xiang He, Ling Jiang, Xiulun Liu, Daokang Xiang

Published 2018-12-20

Cite as Chin J Anesthesiol, 2018, 38(12): 1430-1433. DOI: 10.3760/cma.j.issn.0254-1416.2018.12.006

Abstract

Objective

To evaluate the effect of nicorandil on early prognosis in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).

Methods

Forty American Society of Anesthesiologists physical statusⅡ or Ⅳ patients, aged 18-64 yr, with New York Heart Association gradeⅡ or Ⅲ, scheduled for elective cardiac valve replacement with CPB, were divided into 2 groups (n=20 each) using a random number table method: control group and nicorandil group.Nicorandil was intravenously infused at 10-60 μg·kg^-1·h^-1 (3-15 ml/h) after anesthesia induction until the end of surgery in nicorandil group.Before anesthesia induction (T₀) and at 6, 12, 24, 48 and 72 h after surgery (T_1-5), and when the patients were discharged from hospital (T₆), venous blood samples were obtained for determination of the concentrations of serum cardiac troponin I (cTnI) and brain natriuretic peptide.The events of myocardial ischemia or development of arrhythmia before and after surgery, development of defibrillation during restoration of heart beat, spontaneous heart beat, drug administration during restoration of heart beat, heart rhythm after restoration of heart beat, and the requirement for cardiovascular drugs during and after surgery were recorded.The mechanical ventilation time, duration of intensive care unit stay, and length of postoperative hospital stay were also recorded.

Results

Compared with control group, the concentrations of serum cTnI at T_{2, 3} and brain natriuretic peptide at T_2-6 were significantly decreased, the consumption of intraoperative norepinephrine and postoperative dobutamine was reduced, and the ventilation time and duration of intensive care unit stay were shortened (P<0.05), and no significant change was found in the rate of defibrillation, restoration of spontaneous heart beat, requirement for drugs during restoration, heart rhythm after restoration or duration of postoperative hospital stay in nicorandil group (P>0.05).

Conclusion

Continuously infusing nicorandil during surgery can reduce myocardial injury and improve early prognosis in patients undergoing cardiac valve replacement with CPB.

Key words:

Nicorandil; Cardiopulmonary bypass; Heart valve prosthesis implantation

Contributor Information

Dian Feng

Guizhou Medical University Anesthesiology College, Guiyang 550004, China

Kaiyun Fang