【摘要】 目的了解体外循环(CPB)心脏手术患者外周血管阻力(SVR)的变化规律,研究并探讨硝酸甘油对其影响及意义。方法选择北京大学深圳医院心血管外科心脏瓣膜手术患者160例,随机分为实验组(术中及术后经中心静脉持续泵入硝酸甘油)及对照组,应用连续多普勒血流动力学监测仪(USCOM)测定患者术前、麻醉后、心脏复跳后、术后30min、2h、4h、6h等时相外周血管阻力数值并对比分析。结果两组患者术前SVR无明显差异,对照组患者心脏术后SVR显著升高,以心脏复跳即刻SVR值为最大,心脏复跳后外周血管阻力随时间推移缓慢下降至正常水平。实验组SVR值在不同时相均较对照组有不同程度降低,并较对照组较早恢复至正常水平。结论体外循环心脏手术患者因经受麻醉、低温、非生理性灌注及手术应激等因素影响,外周血管阻力增高,组织恢复生理灌注后,外周血管管阻力可逐步恢复至正常水平。CPB期间应用硝酸甘油可部分降低体外循环心脏手术后患者SVR,改善组织血供,减轻组织缺血、缺氧性损害。更多还原

【Abstract】 Objective To study the influence of glonoin by analyzed the change of systemic vascular resistance in patients with CPB surgery. Methods Collect 160 patients who had the CPB surgery in Peking University Shenzhen Hospital from July 2012 to March 2014. Randomly each patients into experimental group(group A, using glonoine during and after CPB) and control group(group B),80 patients in each group. USCOM was used to measure the patients’ systemic vascular resistance(SVR) before surgery, after anesthesia, after cardiac rebeating, 30minutes/2 hours/4 hours/6hours after the surgery. Results There were no significantly difference of SVR between group A and group B before surgery. The SVR values of group B increased significantly after surgery, and the maximal value appeared at the moment of cardiac rebeating. After surgery, the SVRdecreased slowly to normal as time went on. The SVR of group B were lower than group A in different phase at varying degree, and return to normal earlier than group A. Conclusion The SVR of patients after the CPB surgery increased because of anaesthesia, hypothermia, Non-physiological perfusion and the stress of operation, and would return to normal slowly after the body recovery physiological perfusion. Using glonoine during CPB surgery reduced the SVR value, improve the blood suppl and reduce the anoxic ischemic histologic injury.更多还原