心肺转流中丙泊酚对鱼精蛋白中和肝素后肺高压的影响

摘要

观察心肺转流中丙泊酚对鱼精蛋白中和肝素后引起的肺高压反应的影响.方法心肺转流心脏直视手术鱼精蛋白中和肝素5 min内出现肺高压反应患者51例,随机分为研究组(n=27)和对照组(n=24).研究组在肺高压反应出现后即刻给予丙泊酚1mg/kg,同时缓慢静脉注射10％葡萄糖酸钙0.02 g/kg,并经主动脉缓慢泵入机血.记录注射鱼精蛋白前(T0)、注射鱼精蛋白后5 min(T1)、注射葡萄糖酸钙后1 min(T2)、5 min(T3)、10 min(T4)、20 min(T5)、30 min (T6)时的CVP、气道压(Paw)、MAP.结果 T1、T2时两组MAP均明显下降,CVP、Paw显著上升(P＜0.05).T3时对照组CVP、Paw仍明显高于T0时(P＜0.05),且显著高于研究组(P＜0.05).T4时对照组CVP仍明显高于T0时和研究组(P＜0.05).结论心肺转流中丙泊酚(1 mg/kg)可减轻鱼精蛋白中和肝素后引起的肺高压反应.%Objective To determine whether propofol can prevent pulmonary hypertension induced by heparin-protamine reaction during cardiopulmonary bypass, or not. Methods Fifty-one patients in a total of 2 752 cases who underwent cardiac surgery requiring cardiopulmonary bypass and developed pulmonary hypertension induced by heparin-protamine reaction within 5 minutes were enrolled in the study. The patients were allocated into two groups according to different therapies. In group A (n=24), 10% calcium gluconate was injected intravenously at a dose of 0. 02 g/kg followed by blood pumped through aortic cannula to maintain blood pressure. In group B (n = 27), lmg/kg propofol was injected by central vein at the onset of pulmonary hypertension, followed by the same management as group A. The central venous pressure(CVP), airway pressure(Paw), pulse oxygen saturation(SpO2) and arterial blood pressure (ABP) were recorded before protamine administration (To), 5 min after protamine administration (T1 ), 1 min (T2), 5 min (T3), 10 min (T4), 20 min (T5) and 30 min (T6) after administration of either therapy. Results MAP decreased significantly while CVP and Paw increased significantly at T1 and T2 compared with To in both groups (P<0. 05). CVP and Paw in group A at T3 remained higher than T0 and were also higher than those of group B at T3 (P<0. 05), and CVP in group A at T4 remained higher than T0 and was higher than that of group B at T4(P<0. 05). Conclusion Propofol (1 mg/kg) can reduce pulmonary hypertension induced by heparin-protamine reaction during cardiopulmonary bypass.