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題名 | Hemodynamic Effect of Intravenous Nitroglycerin Immediately following Coronary Artery Bypass Surgery=靜脈用Nitroglycerin對冠狀動脈繞道手術後之血流動力學影響 |
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作者 | 李相臺; 朱樹勳; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 25:2 民81.03-04 |
頁次 | 頁1057-1063 |
分類號 | 418.22 |
關鍵詞 | 靜脈用Nitroglycerin; 冠狀動脈繞道手術; 血流動力學; |
語文 | 英文(English) |
中文摘要 | 靜脈用Nitroglycerin(NTG)有易調劑量,快速作用及持組穩定的藥效,常用於剛做完開心手術之病人在加護病房中維持心臟功能之療藥。 本實驗以二十名冠狀動脈疾之病人為對象。由術前麻醉開始,即給予NTG並維持其劑量介於0.5至5 μg/kg/min。每個病人之心跳,血壓,中心靜脈壓(CVP),肺動脈陸(PAP),肺微血管楔壓(PCWp)及心輸出量(CO)於下刀時及術後每6小時測量一次,並持續至術後36小時。並以上述資料計算得知體血管阻力(systemic vascular resistant SVR,及肺血管阻力(pulmonary vascular resistant PVR )。每次測量後將NTG停掉10分鐘再測量相同資料,做為未使用NTG時之依據。並將使用前後之血流動力學資料做統計學上計算。 結果發現於0.5至5μg/kg/min之劑量下的NTG可使肺動脈壓,肺微血管楔壓,體血管阻力及肺血管阻力明顯下降,而心輸出量明顯上升,並於統計學上有意義。而其血壓及心跳卻沒有改變並於統計學上沒有意義。 由以上結果得知,NTG於0.5至5μg/kg/min之劑量時可增進心臟功能卻不會降低血壓及造成心跳過速。實為冠狀動脈繞道手術後,加護病房照顧之良藥。 |
英文摘要 | The hemodynamic effect of intravenous nitroglycerin (NTG) were studied in 20 patients who underwent the coronary artery bypass surgery. The heart rate, blood pressure, central venous pressure, pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac output were monitored for initial 36 hours after operation. The intravenous NTG dose was given between 0.5 to 5 μg/kg/min and the hemodynamic changes before and after the NTG use were documented, calculated and analyzed with Fisher test. These data showed that in comparing with non-NTG and NTG data, the mean pulmonary artery pressure [26.00±3.16 mmHg vs 19.84± 5.67 mmHg, p < 0.01 ], pulmonary capillary wedge pressure [16.21± 4.72 mmHg vs 10.78± 3.55 mmHg, p < 0.05 ], systemic vascular resistant [2049±226.16 dynes.s.cm-5 vs 1290.00±187.96 dynes.s.cm-5, p < 0.05] and pulmonary vascular resistant [174.05±42.94 dynes.s.cm-5 vs 116.68±19.70 dynes. s.cm-5 p < 0.05 ] were significantly decreased while the cardiac output was significantly increased [3.78±0.43 L/min vs 5.40±1.08 L/min, p < 0.05 ] after NTG use. However the mean blood pressure [92.53± 8.75 mmHg vs 83.80±12.09 mmHg, p > 0.05] and heart rate [103.84±9.38 beats/ min vs 101.30±7.56 beats/min ] were not significantly changed before and after the NTG use. In conclusion, the intravenous NTG significantly improved the hemodynamic status immediately following coronary artery bypass surgery. |
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