摘要
目的:探讨非体外循环冠状动脉旁路移植术(OPCABG)围术期血管麻痹与内源性血浆血管加压素(AVP)之间的关系,并探究血管麻痹的相关危险因素。方法:随机选择择期行OPCABG患者50例,分别在麻醉诱导前、切皮前、切皮后10分钟、切皮后30分钟、给鱼精蛋白后10分钟、术毕、术后24小时采集动脉血液样本测定血浆AVP浓度以及血管紧张素Ⅱ(AngⅡ)浓度,并记录相应时间点血流动力学数据。根据术中血浆AVP浓度的不同变化水平,通过系统聚类分析统计方法自动将50例患者分为高值组(n=26)和低值组(n=24)。详细记录患者围术期临床资料。结果:术前使用β受体阻滞剂(OR=0.256,P<0.05)、术前使用血管紧张素转换酶抑制剂(ACEI)(OR=0.292,P<0.05)、术前使用血管紧张素受体拮抗剂(ARB)(OR=0.347,P<0.01)、术前高血压史(OR=0.266,P<0.05)均与术中低外周血管阻力指数(SVRI)具有显著相关性。术前左心室射血分数(OR=1.122,P<0.01)与低值组围术期AVP浓度具有显著相关性。结论:OPCABG围术期也可发生血管麻痹。围术期内源性AVP浓度较低是导致术中发生血管麻痹的机制之一。术前使用β受体阻滞剂、ACEI、ARB及术前患高血压史均是OPCABG围术期发生血管麻痹的相关因素;术前低左心室射血分数是导致围术期低AVP浓度的危险因素。
Objective：To explore the relationship between peri-operative plasma level of arginine vasopressin（AVP） and vascular paralysis in patients undergoing off-pump coronary artery bypass grafting（OPCABG） and to analyze the related risk factors. Methods：A total of 50 patients with elective OPCABG were studied. Plasma levels of AVP and angiotensin II （AngII）were examined at the following time points -before anesthesia induction, before skin incision, l0 rain after skin incision,30 rain after skin incision, 10 min after protamine injection, end of the operation and 24 hours after the operation. According to peri-operative plasma AVP level, the patients were automatically divided into High AVP group, n = 26 and Low AVP group, n = 24 by hierarchical clustering analysis method. The clinical information at peri-operative period was closely monitored in all patients. Results ： Pre-operative use of [5-receptor blocker （ OR = 0. 256, P 〈 0.05 ）, angiotension converting enzyme inhibitor （ ACEI ） （ OR = 0. 292, P〈0.05 ）, angiotensin receptor blocker（ARB） （ OR = 0. 347, P〈0. 01 ） and the patients with previous history of hypertension（ OR = 0. 266, P〈0. 05 ）were significantly related to peri-operative low systemic vascular resistance index （SVRI）. Preoperative left ventricular ejection fraction（LVEF）（OR= 1. 122,P〈0.01） was significantly related to plasma AVP level in Low AVP group. Conclusion：Vascular paralysis could occur at peri-operative period of OPCABG, lower plasma AVP level is one of the reasons. Pre-operative use of ACEI, ARB, B-Receptor blocker and previous history of hypertension are related factors for vascular paralysis. Low pre-operative LVEF is the risk factor for decreasing plasma AVP level.
出处
《中国循环杂志》
CSCD
北大核心
2012年第1期60-63,共4页
Chinese Circulation Journal
