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| 亚甲蓝在感染性心内膜炎患者行心脏瓣膜置换术中的应用效果 |
| Effect of methylene blue in infective endocarditis patients undergoing cardiac valve replacement with cardiopulmonary bypass |
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| DOI：10.12089/jca.2019.10.011 |
| 中文关键词: 亚甲蓝 心肺转流 感染性心内膜炎 血管麻痹综合征 |
| 英文关键词: Methylene blue Cardiopulmonary bypass Infective endocarditis Vasoplegic syndrome |
| 基金项目: |
| 作者 | 单位 | E-mail | | 马亚飞 | 471000,河南省洛阳市,河南科技大学临床医学院,河南科技大学第一附属医院心血管外科麻醉组 | 21293408@qq.com | | 魏利娟 | 471000,河南省洛阳市,河南科技大学临床医学院,河南科技大学第一附属医院心血管外科麻醉组 | | | 冯毅 | 471000,河南省洛阳市,河南科技大学临床医学院,河南科技大学第一附属医院心血管外科麻醉组 | | | 郭仲辉 | 471000,河南省洛阳市,河南科技大学临床医学院,河南科技大学第一附属医院儿科 | |
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| 中文摘要: |
目的 观察亚甲蓝在感染性心内膜炎患者行心脏瓣膜置换手术中的应用效果。
方法 选择2016年10月至2018年11月拟行心脏瓣膜置换术的感染性心内膜炎患者30例,男21例,女9例,年龄38～67岁,ASA Ⅱ—Ⅳ级,采用随机数字表法分为两组:亚甲蓝组(MB组)和对照组(C组),每组15例。MB组于CPB停机前10 min开始泵注亚甲蓝2.0 mg／kg持续20 min,C组于相同时点注入等剂量生理盐水。记录术中总输液量、术后机械通气时间、ICU停留时间;分别于给肝素前(T1)、CPB停机后10 min(T2)以及静注完亚甲蓝后1 h(T3)、3 h(T4)、6 h(T5)和12 h(T6)时记录HR、MAP、CVP、HR与SBP的乘积(RPP)、正性肌力药物评分(IS)和血管活性药物评分(VIS)以及血糖和乳酸浓度。
结果 与T1时比较,T2—T6时两组IS、VIS、血糖和乳酸浓度明显升高(P＜0.05);与C组比较,T3—T6时MB组IS、VIS、RPP和乳酸浓度明显降低(P＜0.05),术中总输液量明显减少(P＜0.05),术后机械通气时间和ICU停留时间明显缩短(P＜0.05)。
结论 亚甲蓝在感染性心内膜炎患者行心脏瓣膜置换手术中早期预防应用,可减少术中液体输注量和术后血管活性药物应用,降低心肌氧耗,缩短术后机械通气时间和ICU停留时间。 |
| 英文摘要: |
Ojective To observe the effect of methylene blue (MB) in infective endocarditis patients undergoing cardiac valve replacement with cardiopulmonary bypass.
Methods Thirty patients with invasive endocarditis who underwent heart valve replacement from October 2016 to November 2018, 21 males and 9 females, aged 38-67 years, falling into ASA physical status Ⅱ-Ⅳ, were randomly divided into two groups using random number table method (n = 15): group MB and control group (group C). The patients in group MB were intravenously infused MB 2.0 mg／kg for 20 min at 10 min before the end of cardiopulmonary bypass. The patients in group C was infused the same does of normal saline at the same time and route. The total intraoperative fluid volume, postoperative mechanical ventilation time, and ICU stay time were recorded. The HR, MAP, CVP, real portfolio project (RPP), inotrope score (IS), vasoactive inotrope score (VIS), blood glucose and lactate were recorded at different time points: before heparin (T1), 10 min after cardiopulmonary bypass (T2), and 1 h (T3), 3 h (T4), 6 h (T5), and 12 h (T6) after intravenous injection of MB.
Results Compared with T1, the levels of IS, VIS, blood glucose and lactate were significantly increased in the two groups at T2-T6(P < 0.05). Compared with group C, IS, VIS, RPP and lactic acid were significantly decreased, total intraoperative fluid volume were decreased, postoperative mechanical ventilation time and ICU stay time were shortened in group MB at T3-T6(P < 0.05).
Conclusion Early prevention of methylene blue in patients with infective endocarditis undergoing heart valve replacement surgery can decrease intraoperative fluid infusion and postoperation vasoactive drug application, reduce myocardial oxygen consumption, and shorten postoperative mechanical ventilation time and ICU stay time. |
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