【作者】 李向宇； 柳垂亮； 潘飞鹏； 黎涌； 招伟贤；

【Author】 LI Xiang-yui LIU Chui-lian PAN Fei-peng LI Yong ZHAO Wei-xian~*.*Department of Anesthesiology,Guangdong Provincial Hospital of TCM,Guangzhou 510120,China

【机构】 广东省中医院麻醉科；

【摘要】 目的观测非体外循环冠脉搭桥术（OPCABG）中参附注射液对血流动力学和全身氧代谢的影响。方法选择冠心病择期行OPCBG手术病人56例,随机分为SF组和NS组。SF组在手术切皮前和吻合心脏血管前各静脉注射参附注射液40ml,NS组则分别注射等量生理盐水。用漂浮导管和动脉、混合静脉血气分析监测麻醉手术过程血流动力学和全身氧代谢。结果在吻合后降支或右冠状动脉（T₅）和左回旋支或对角支（T₆）时;两组的CI和SI均明显低于对照值,其中在锯胸骨后（T₂）和T₅,SF组的CI略高于NS组（P<0.05）。整个麻醉手术期间,SF组的HR、MAP、LVWI和RVWI均显示略高于NS组（P<0.05）。两组的pH在手术开始后均呈降低变化,其中SF组术毕的pH明显低于NS组（P<0.05）。手术期间两组的HCO₃^-、BE-E和TCO₂均呈下降,两组间在多个时间点存在显著统计学差异（P<0.05 0.01）。SF组对照点的DO₂高于NS组,但术中两组间VO₂、O₂ext和T的变化未见显著差异（P<0.05）。结论 ASAⅡ～Ⅲ级病人非体外循环冠脉搭桥术中,在循环功能和氧供/氧耗相对稳定条件下静脉给予参附注射液,未见对血流动力学和氧代谢参数产生显著影响。更多还原

【Abstract】 Objective To investigate the effect of Shenfu injection on hemodynamics and oxygen metabolism in off-pump coronary artery bypass grafting. Methods Fifty-six ASAⅡ～Ⅲpatients undergoing elective OPCABG were randomly divided into two groups,Shenfu group（SF,n=29） and Normal saline group （NS,n=27）.The SF group patients received Shenfu injection 40ml through central vein twice,respectively after anesthesia induction（T₁） and before the beginning of graft anastomoses（T₃）.As control group,the NS group patients received Normal Saline instead of Shenfu injection in the same volume.Two methods were utilized for hemodynamics and Systemic oxygen metabolism monitoring during anesthesia and surgery.One was Pulmonary artery catheterization,the other was arterial and mixed venous blood gas analysis.Results In both gourps,CI and SI at T₅（anastomose posterior descending artery or right coronary artery） and T₆（anastomose circumflex coronary artery or diagonalbranch） were significantly lower than baseline.CI in SF group at T₂（after sternotomy） or T₅ were slightly higher than NS group（P<0.05）. During the operation,HR,MAP,LVWI and RVWI in SF group were slightly higher than NS group（P<0.05）.PH decreased approximately with time change in both groups and after the Operation PH in SF group was markedly lower than NS group （P<0.05）.During the operation,HCO₃^-,BE-E and TCO₂ has descend trend in both groups and has significant statistical difference at multiple time points between the groups（P<0.05～0.01）.Baseline of DO₂ in SF group is higher than NS.But between the groups no significant difference（P>0.05） was found for VO₂,O₂ext and T during the operation.Conclusion In OPCABG,under the condition that the circulatory function and oxygen supply/oxygen consumption are relatively stable,Giving Shenfu Injection intravenously to ASAⅡ～Ⅲgrade patients has no beneficial effect on the hemodynamic parameters and oxygen metabolism parameters.更多还原