风湿性心脏病合并肺动脉高压患者瓣膜置换术中应用尼可地尔对肺血流动力学的影响

摘要

Objective To observe the effect of nicorandil on pulmonary hemodynamics in rheumatic heart disease ( RHD) complicated with pulmonary arterial hypertension ( PH) patients underwent cardiac valve replacement surgery. Met-hods Sixty cases of RHD combined with PH for valve replacement were randomly divided into 2 groups, 30 cases in each group. The observation group patients received oral nicorandil before anesthesia, patients in the control group without taken any medicine. The 2 groups of patients' relevant indicators, operation body hemodynamic index and mean pulmonary artery pressure (MPAP), pulmonary vascular resistance (PVR) and the pulmonary hemodynamic parameters were observed and compared. Results Observation group's intraoperative amount of sodium nitroprusside were significantly lower than in the con-trol group ( t =3. 673, P <0. 05), and cardiopulmonary bypass time, aortic cross-clamping time, operative time, dopamine dosage,mechanical ventilation time,intraoperative amount of bleeding, intraoperative fluid volume, urine and other periopera-tive differences did not show statistically significant ( P >0. 05); using the preoperative (T0) as a reference, administered nicorandil 20 min ( T1 ) , administered 40 min ( T2 ) , before bypass ( T3 ) , the observation group's MPAP and PVR were sig-nificantly decreased ( P <0. 05), control group did not show significant decrease ( P >0. 05), 2 group's differences were statistically significant ( P <0. 05), other hemodynamic indices in the intra-group showed statistically significant differences P<0. 05), no statistically significant differences between the 2 groups were found ( P >0. 05). Conclusion Application of nicorandil in patients with RHD combined PH during aortic valve replacement can reach stable bypass blood circulation, re-duce the pressure of pulmonary artery and pulmonary circulation resistance, it is efficacy and safety for helping to guarantee the operation.%目的：观察风湿性心脏病( RHD)合并肺动脉高压( PH)患者在瓣膜置换术中应用尼可地尔对肺血流动力学的影响。方法行瓣膜置换术的RHD合并PH患者60例,随机分为2组,每组30例。观察组患者于麻醉前口服尼可地尔,对照组患者不给药。对2组患者的手术相关指标、体循环血液动力学指标及平均肺动脉压( MPAP)、肺循环阻力( PVR)等肺循环血流动力学指标进行观察和比较。结果观察组患者术中硝普纳用量显著低于对照组(t =3.673, P <0.05),而体外循环转流时间、主动脉阻断时间、手术时间、多巴胺用量、机械通气时间、术中出血量、术中补液量、围手术期尿量等差异均无统计学意义( P >0.05)；以术前( T0)为参照,在尼可地尔给药20 min( T1)、给药40 min(T2)、转流前(T3),观察组患者MPAP和PVR均显著下降( P <0.05),对照组未见显著下降( P >0.05),2组比较差异有统计学意义( P <0.05)；其他血液动力学指标组内差异有统计学意义( P <0.05),组间差异均无统计学意义( P >0.05)。结论在RHD合并PH患者瓣膜置换术中应用尼可地尔,可达到稳定患者转流期间的血液循环、降低其肺动脉压力和肺循环阻力的目的,有助于保障手术的治疗效果和安全性。