尼卡地平对体外循环复温期的影响及降压效果的研究

目的:研究尼卡地平在体外循环中控制降压的效果并观察复温期中心温度和外周温度差及对复温速度的影响.方法:选择期心脏瓣膜置换术患者60例,随机分为三组,尼卡地平(N)组,硝普钠(S)组,对照(C)组,每组20例.在体外循环(CPB)中平均动脉压(MAP)升至10.65kPa时给予尼卡地平或硝普钠,观察二药起效时间、维持MAP在6.65-9.30kPa时所需剂量、中心温度与外周温度差、温度平衡的时间、开放升主动脉后心脏自动复跳情况及停机后血流动力学的变化.结果:开放升主动脉后N组18例自动复跳(90%),S组14例(70%)自动复跳,两组的复跳率均高于对照组11例(55%)(P＜0.05),N组复跳率高于S组(P＜0.05).停机后两组外周阻力(SVR)较CPB前明显下降(P＜0.01),每搏量(SV)和心指数(CI)均明显增加(P＜0.01),与对照组比较有显著差异(P＜0.01),但SVR降低,SV和CI增加的比例两用药组间无明显差异(P＞0.05).复温期N组鼻咽温11min达到复温要求,S组17min达到复温要求,C组23 min才达到温度要求.结论:CPB中应用尼卡地平具有复温快、温度平衡快,控制血压起效快,心脏自动复跳率高,停机后心率平稳.

STUDY REWARMING PERIOD AND ANTIHYPERTENSIVE EFFICACY BY NICARDIPINE IN CPB

Objective:To study the antihypertensive efficacy by nicardipine in CPB,and observe the rewarming velocity and alternation of central and cirumferential temperature in rewarming period.Method: 60 cases with selected CPB were divided into three groups,each of them with 20 cases,N group(nicardipine),S group(sodium nitroprusside),C group(control).When the MAP ascend to 10.65kPa during CPB,nicardipine and sodium nitroprusside were given.And then observe the drug effect,the dosage to maintein MAP in 6.65-9.30kPa,alternation of central and cirumferential temperature,the time for balancing temperature,results after opening the aorta clamp hearts automatic rebeated and the changes of hemodynamics after shut down.Result: There're 18 cases(90%),14 cases(70%),11 cases(55 %) with hearts automatic rebeated after opening the aorta in N,S,C group respectively.(P<0.05),the rate of hearts automatic rebeated in N group are superior to that in S group(P<0.05)?Comparing with before CPB,SVR decreased in N and S group(P<0.01),SV and CI increased obviously(P<0.01),There's significant difference comparing with C group(P<0.01),SVR decreased,While there's no difference of SV and CI increases between N and S group during the period(P>0.05)?After 11 min,17 min,23 min in N group,S group,C group respectively rewarming in rewarming period.Conclusion:It's faster in rewarming,balancing temprature,controlling blood pressure with nicardipine,and with high rate of hearts automatic rebeated and stable of heart rate after shut down.