李立环β阻滞剂在围手术期的应用english.ppt

β阻滞药在围手术期的应用Perioperative Application of β-Adrenergic Receptor Blocker 李立环Li Lihuan 北京阜外心血管病医院 Fu Wai Hospital (Beijing) ?-阻滞药治疗高危血管外科的疗效Effect of β-blockor in treating high risk vascular surgery  ? 美国?-阻滞药治疗急性心梗回顾性研究Retrospective study of β-blocker ‘s therapy in acute myocardial infarction in USA β－阻滞药围术期心脏的保护作用Heart protective effect of β-blockor in perioperative period 北京阜外心血管病医院麻醉科从90年起术中尝试使用β－阻药处理心脏事件，取得的效果挑战了对心脏事件处理的传统观念 The department of anaethesia of our hospital has tried using β-blockor to treat cardiac events since 1990’s and its results challenged the traditional concept of treating these events. 病例(case) 体外循环下冠脉搭桥 (CABG under cardiopulmonary bypass) 术前病情偏重，EF约40％， 未放置漂浮导管; Relatively severe condition before operation, EF about 40%,pulmonary artery catheter unlocated; 停机时给予0.03ug/kg/min肾上腺素辅助循环; 0.03ug/kg/min epinephrine to support circulation stability after stopping cardiopulmonary bypass; 静注鱼精蛋白循环尚稳定; Hemadynamic stability during protamine intravenous administration;鱼精蛋白注毕后约5min血压下降，加大肾上腺素用量血压上升; Blood pressure decreased 5 minutes after portamine administration ，elevated after increasing dose of epinephrine;数分钟后出现下列临床征象 Following symptoms occurred few minutes later 临床症状(clinical symptoms) 急性肺水肿，粉红色泡沫样痰 Acute pulmonary edema, pink foaming spittle 高气道压力 High pressure in airway 心电图ST段明显抬高 ST segment elevated significantly in ECG 反复恶性心律失常：室速 室颤 Repeated fatal arrhythmia: ventricular tachycardia, ventricular fibrillation 低血压(SBP70~75mmHg) Hypotension 治疗经过Therapeutic process 美托洛尔1mg后血压维持原水平略有上升，室速室颤频率 ?，心率减慢约3～4bpm After 1mg metoprolol administration , blood pressure elevated, occurrence of VT ,VF decreased, heart rate reduced by 3～4bpm 美托洛尔1mg后血压上升到80~85～90mmHg，室速室颤消失，ST段恢复，循环稳定 After 1mg metoprolol administration ,VT,VF vanished, ST segment lowered to normal and hemodynamic stable when blood pressure increased to 80~85～90mmHg β－阻滞药围术期脑保护作用Brain protective effect of β-blo