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| 尼卡地平对冠状动脉旁路移植术患者脑血流和功能的影响 |
| Effects of nicardipine on cerebral blood flow and function in patients undergoing coronary artery bypass grafting |
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| DOI：10.12089/jca.2023.08.006 |
| 中文关键词: 冠状动脉旁路移植术 心肺转流 颈内动脉血流 局部脑氧饱和度 |
| 英文关键词: Coronary artery bypass grafting Cardiopulmonary bypass Internal carotid blood flow Regional cerebral oxygen saturation |
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| 中文摘要: |
目的 探讨冠状动脉旁路移植术（CABG）患者在心肺转流（CPB）期间输注小剂量尼卡地平对脑血流和功能的影响。
方法 选择CPB下CABG患者64例，男41例，女23例，年龄60～79岁，BMI 18～29 kg/m2，ASA Ⅱ或Ⅲ级，NYHA分级Ⅱ或Ⅲ级，左室射血分数≥50%。采用随机双盲数字表法将患者分为两组：尼卡地平组（N组）和生理盐水组（C组），每组32例。N组在CPB开始后输注尼卡地平0.2～0.5 μg·kg-1·min-1，于CPB停机后停止输注。C组于相同时点输注同等容量生理盐水。记录麻醉诱导前（T0）、外科切皮时（T1）、CPB 30 min（T2）、60 min（T3）、停CPB 30 min（T4）、60 min（T5）的动脉血气、心输出量（CO）、颈内动脉血流量（Q-ICA）、颈内动脉直径（D-ICA）和局部脑氧饱和度（rScO2）。记录术中去氧肾上腺素用量、术后拔管时间、ICU停留时间和术后住院时间。
结果 与C组比较，T2—T5时N组Q-ICA和D-ICA明显增加，rScO2明显升高（P＜0.05）。两组T0—T5时动脉血气指标、T0、T1时Q-ICA、D-ICA和rScO2、术中去氧肾上腺素用量、术后拔管时间、ICU停留时间和术后住院时间差异均无统计学意义。
结论 在CABG患者CPB期间输注小剂量尼卡地平可以增加颈内动脉血流量，升高rScO2，减轻围术期神经功能损伤。 |
| 英文摘要: |
Objective To investigate the effects of low-dose nicardipine infusion on cerebral blood flow and function in patients undergoing coronary artery bypass grafting (CABG).
Methods Sixty-four patients with CABG under CPB were selected, 41 males and 23 females, aged 60-79 years, BMI 18-29 kg/m2, ASA physical status Ⅱ or Ⅲ, NYHA Ⅱ or Ⅲ, left ventricular ejection fraction ≥ 50%. The patients were divided into two groups using a randomized double-blind number table method: nicardipine group (group N) and saline group (group C), 32 patients in each group. Group N was infused with nicardipine 0.2-0.5 μg·kg-1·min-1 after the start of CPB, and the infusion was stopped after the CPB stopped. Group C was infused with the same volume of normal saline at the same time point. The arterial blood gases, cardiac output (CO), quantity of flow of the internal carotid artery (Q-ICA), diameter of the internal carotid artery (D-ICA), and local cerebral oxygen saturation (rScO2) were recorded before anesthesia induction (T0), during surgical skin resection (T1), 30 minutes after CPB started (T2), 60 minutes after CPB started (T3), 30 minutes after CPB stopped (T4), 60 minutes after CPB stopped (T5). Intraoperative phenylephrine dose, postoperative extubation time, the length of ICU and postoperative hospital stay were recorded.
Results Compared with group C, Q-ICA and D-ICA of group N were significantly increased at T2-T5, and rScO2 was significantly increased (P < 0.05). There were no significant differences in arterial blood gas indexes at T0-T5, Q-ICA, D-ICA and rScO2 at T0 and T1, intraoperative dosage of norepinephrine, postoperative extubation time, ICU stay and postoperative hospital stay between the two groups.
Conclusion During CPB in CABG patients, low-dose nicardipine infusion can increase internal carotid blood flow and rScO2, and reduce perioperative nerve function impairment. |
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