TAP CHr NGHIEN C l f U Y HOC
DANH GIA MOT SO TAC DUNG TREN HUY^T DONG CUA DOBUTAMIN & BENH NHAN G I A M LUU LUONG TIM
SAU PHAU THUAT BENH VAN TIM
Tran Mai H u n g \ Nguyen HO'u Td^
'Benh vidn Tim Hi Ndi, ^Trw&ng Dai hpc Y Ha N^
Nghien cu'u nhim danh gii sw cai thien Itru luang tim sau phau thu$t va cac tac dung bit lgi cda Dobutamin tren mpt sd chi sd huydt dong cua benh nhan phiu thuat cac benh van tim. Kdt qua cho thiy sau 1 gio nhip tim tang 101.56 ± 17.54 so v&i 81,91 ± 13,14 nhip (p < 0.05), Iwu Iw&ng tim tang 4,10 ± 0,55 (l/phut/m% chis6 tim (Cl) tang 2,83 ± 0,51 (l/phut/n^)- Sau 6 gi&nhip fim tang 112,50 ± 18,17so vol 81.91 ± 13,14 nhip (p < 0.05). twu twong tim ting 4,38 ± 0,42(l/phut/m^) so v&i 2,72 ± 0,55 (/phut/m^) tnr&c dOng Dobutamin (p < 0,05). chi sd lim sau 6 gi& 3,08 ± 0.27(l/phut/m^) so vdi tnr&c dung Dobutamin 1.90 ± 0,29 (l/phut/m^) vol (p < 0.05). The tich nhit bdp (SV) tang 42,29 ± 10,52ml so v&i tnroc dung Dobutamin 34,59 ± 8,31ml (p < 0,05). Kit luan Dobutamin oil thien tich cue vi ding ke thd tich nhit bdp, Iwu luvng tim. chis6 tim. giam sue can phoi. giam sirc can he thong sau 1 gio. Tuy nhien lim tang nhip tim cd y nghTa thong kS ngay sau khi dimg va keo dai t&i th&i diem ngimg thudc.
Tip khoa: giam liru Iwgng tim, p h l u thuat tim mach, Dobutamin'e
I. OAT
VANBt
Giam luu luang tim do giam sirc co bdp ea lim Ihudng gap sau p h l u thuat lim vdi s u tra giiip cua he thdng t u l n hoan ngoai c a the [ 1 ; 2] N h i i u y i u Id phdi hap la nguyen nhan ciia hdi ehirng nay ban than tim da bi suy trude mo, benh ly n h i i u van tim, thieu mau ea lim keo dai trong thai gian cap dong mach ehu, c h i n thuang true t i i p len lim do cae can thiep p h l u thuat, ton thuang lai l u d i mau, giam co bdp ca tim do dung dich lam hel tim (cardioplegie), hoat hoa he t h i n g viem . Viec su dung thuoc tra tim cd vai trd cai thien luu luang tim, r l t quan trgng trong viee hdi phue hoat ddng cua lim sau p h l u thuat Cae thude trg tim d u g c sir dung nhu Dopamin, Dobutamin, Dopexamin, Epmephnn, Milrinon, Enoximon, Norepmephrm, Levosimendan..
Dia Chilian he Tran fvlai Hung, beni) v^n Tim Ha Noi, Email hungvt1168@gmail com
Ngaynhan 12/01/2014 Ngay duoc chap thuan 28/4/2014
Trong dd, Dobutamin d u a e dung pho biin tai eac trung tam p h i u thuat tim mach [3, 4; 5]
Dobutamin cd lae dung lam tang truang l^c c a tim, tang sirc co bdp cua tim, giiip tSng luu luang tim. Tuy nhien, cho tdi nay tai Vi^t Nam chua cd nghien ciru nao d u a c cdng bo ve hieu qua cua Dobutamin trong d i i u trj giam luu lug'ng tim sau p h i u thuat van tim vdi tuln hoan ngoai c a the. Viec diing thudc trp* tim cdn phu thudc n h i i u vao kmh nghiem cOacac bac sy gay me, hdi sire. X u i t phat lir thi/c ^ tren, chiing tdi t i i n hanh nghien ciru nay mgc dieh danh gia s u cai thi^n luu luang tim va mdt sd chT'sd h u y i l dgng va tae dung bit ii?i cua Dobutamin d benh nhan sau p h l u thu$t van lim.
II. D 6 1 TU'gNG VA PHU'aNG PHAP
1. Odi l u ' a n g
Chimg tdl t i i n hanh nghien cu'u tgi b$nh vien Tim Ha Ndi lir thang 2 nam 2011 iJ^i thang 9 nam 2011
TCNCYH 87 (2) - 2014
• TAP CHI NGHIEN C U ^ Y HOC Ti^u chuan lira chgn: b&nh nh^n ngudi
ldn duox; p h i u thuat thay hoac sua van tim, dug'c chan doan giam luu luang tim sau p h i u thuat (do luu luang lim qua catheter Swan - Ganz 7Fr), d u a c d i i u tri giam luu lugng tim blng dobutamin va benh nhan ddng y tham gia nghiSn ciru
Tieu chuan loai trie: benh nhan cd tinh tr?ng nang Irudc p h l u thuat (NYHA IV, dang sir dung catecholamine), benh phdi hap khac (benh ly phoi man tinh, tinh trang nhidm triing ) cd b i i n ehirng nang eua gay me - hdi sire hoac p h l u thuat.
2. Thidt ke nghien cii'u
Nghien ciru can thiep lam sang t i i n ciru l u doi chirng. Thuc hien tir thang 2 d i n thang 9 nam 2011 tai benh vien Tim Ha Ndi.
So lieu dug'c xii" ly b l n g chuang trinh SPSS 16 0 Cac thuat loan sir dung bao gdm Test Student, Wilcoxon, p < 0,05 dugc coi la cd khae biet
3. Quy trinh nghien cii'u
Catheter Swan - Ganz 7Fr hang san x u l t B Braun Germany Dat qua tTnh mach eanh trong theo phuang phap Seldmger vi tri choc ngang sun n h i n He thdng d u o c ndi vdi monitor Philips qua bd phan cam b i i n (transducer), cho phep do ap lue nhi phai, ap luc ddng maeh phoi, ap lue mao maeh phoi bit va thdng qua phuang phap pha loang nhiet de do luu lugng tim (CO), do 3 lan lien tuc, l l y giStrj trung binh.
Quy trinh chuan bi p h l u thuat, xet nghiem, gay m6, tim phoi may nhan tao, p h i u thuat va hfii sii'c theo eung mdt quy trinh ap dung tai b^nh vien tim Ha Ndi P h i i u thu thdp thdng tm bao gom day du cae ehi tieu nghien cuu
Su" di^ng dobutamin trong nghien cO'u Sau khi da ngirng may t u l n hoan ngoai co- the, d i i u chinh nhip hm, bii dich du duy tri
PVC > 12 mmHg ma h u y i t ap ddng mach tam thu < 90 mmHg. Cl < 2,2 lit/phut/m^ thi cd ehi dinh diing Dobutamin Chiing tdi diing Dobutamin vdi l i i u khdi d l u 7 p/kg/phiit dh danh gia trong nghien ciru [6; 7] Sau 20 phut n i u Cl < 2,5 lil/phill/m^ h u y i t ap ddng mach tam Ihu < OOmmHg, tang 2pg/kg/phut mdi 10 phiit d i n khi dat duge gia tri v i huyet ddng Cl
> 2,5 lil/phiit/m^; h u y i t ap ddng mach tam thu
> 90 mmHg Vdi hiu Dobutamin >10pg/kg/
phut khdng cai thien huyit ddng dting them Noradrenalm vdi l i i u 0,1pg/kg/phiil
Cac thdng sd v i h u y i t ddng theo ddi tai cae thai d i i m ; t r u d d d i i n g Dobutamin I h - 6h- 12h - 24h - 48h Ghi nhan cac tai b i i n va tac dung phu ciia Dobutamin
Cae chl sd hoa smh Ure, creatinine, dudng huyit, dien giai dd, men gan (ALT S AST), CK, CK - MB, khi mau ddng mach (tai thai diem sau khi v i hdi sire, sau mo 24 gid, 48 gid).
B^nh nhan duac sieu am qua thanh nguc tai giudng, dam bao su hoat ddng binh thudng ciia van tim nhan tao va khdng cd chen ep tim d p do dtch hay do huyet khdi
4. Qao du'c nghien c i r u
Nghien cuu duac c h i p thuan bdi Hdi dong khoa hoc benh vien Tim Ha Ndi Moi thdng tin nghien ciru deu duoc giCr bi mat, ehi phuc vu muc dich nghien cuu
III. K^T QUA
Cd 8,8% benh nhan thay hoae sura 1 van (chl thay van 2 la hoac van ddng mach chii) 35,3% benh nhan thay hoac sua van 2 la va sua van 3 la va 55,9% benh nhan thay van 2 la, thay van ddng maeh chu va sua van 3 la ehiem Nhu vay, benh nhan ton ihuong cang nhiiu van nguy ca dimg thudc tra tim cang cao
TCNCYH 87 (2)-2014 107
TAP CHi NGHIEN CUTJ Y HOC
Bang 1 . Dac d i i m cac benh nhan nghien cu>u
Dac digm Tuoi
Chl s6 tim - ngyc {%}
Dien tich ca the (m^) Di^CTng kinh th§t trai (mm) Phan xuat tong mau' EF{%) Ap iLKC dong mach ph6i tam thu (mmHg) Thai gian tuan hoan ngoai CO' the Cap dong mach chu Thai gian p h l u thuat Thai gian gay me
Rung nhT Xoang
n = 34 ( X ± SD) 4 4 ± 1 1 , 8 0,68 ± 0 . 1 1.43 ± 0 , 1 58.16 ± 1 4 , 5 0 51.39± 10,17 62,50 ± 2 1 . 6 2 102,3 + 39.1
81.1 ± 3 2 , 4 165,7 ± 4 8 , 2 195,7-±46,2
20 (58, 8%) 14(41,2%)
Min - max 2 3 - 6 2 0 . 6 - 0 . 9 1 . 1 4 - 1 . 8 3 5 - 8 9 , 5 3 2 - 68 2 5 - 1 1 0 48 - 208 3 7 - 1 5 0 86 - 270 1 1 5 - 3 0 0
+ Chi sd tim nguc tren phim chup XQ Idn, blnh thudng < 0,5
+ Dudng kinh t h i t trai trude mo trung binh 58,16 ± 14,50 Idn n h l l 89,5 mm
+ Ap luc ddng mach phdi cao, trung binh 62,50 ± 21,62. Tang ap luc ddng mach phoi dac biSt t h l y tren benh nhan hep khit van 2 la Trudng hap cao n h l t 110 mmHg
Bang 2. Ket qua hoa s i n h tai cac thd'i d i l m n g h i e n CLPU
Hoa sinh Creatinine CK CK - MB AST ALT Ure
Triro'c mo n = 34 ( A ' ± SD)
77,87 ± 2 4 , 5 3 72,38 ± 36,54 14,13 + 9,49 34,26 ± 9 , 3 0 30,21 ± 1 1 , 5 8 8,06 ± 11.27
Ve hoi siJc n = 3 4 ( A ' + S D )
77.58 ± 27,62 255,26 ± 162,05*
43,05 ± 15,47*
45,10 + 35,19*
45,02 ±91,37 6.6 ± 2 . 3 3
Sau m 6 24h n = 3 4 ( J ± S D )
86.07 ± 2 9 . 1 2 299,86 ± 2 3 2 , 4 6 * 49,48 ± 34,96*
69,71 ± 5 5 , 8 8 * 46,66 ± 8 4 , 5 10,1 ± 14,76
Sau m6 48h n = 3 4 ( X ± S D )
84,08 + 28,54
62,42 ± 32,34*
42,8 + 66,05 11,8±17.1
p < 0,05 cd y nghTa so vdi trude khi dimg Dobutamin
Mdt sd chi s6 hda sinh mau thay doi cd y nghTa thdng ke trude va sau diing Dobutamin (p < 0,05) tuy nhien van n i m trong gidi han cae chi so binh t h u d n g cua ngudi Vidt Nam.
TCNCYH 87 (2) - 2014
• TAP CHI NGHIEN CCPU Y HOC Bang 3. Thay d6J huydt dong tru>ac va sau d u n g Dobutamin
Tru'O'c n = 34
Sau 1h n = 34
Sau 6h Sau 12h Sau 24h n = 34 n = 34 n = 34
Sau 48h n = 34
HR CO SV Cl MAP
CVP
MPAP PCWP SVR Lieu Dob Lieu Nor
J±SD 81,91 ±
13.14 2.72 ±0.55 34,59 ± 8,31 1,90 ±0,29 65,05 ± 8,96
12.68 + 2.53 28,56 ±
13.64 17,52 ±3,96
1622.41 ± 444,94
XiSD 101.56 ±
1754*
4.10 ±0.85*
42.29 ± 10.52*
2,83 ±0,51*
79.96 ± 10.21*
12.6212.51 26,63 ±
11.04 15,80 ± 3,97-
1378,0 ± 437,43*
7.0 ±0,79 XiSD
112.50 ± 18,17*
4,38±0,42*
39,33 ± 7,73*
3.08 ±0.27*
82.65 ± 11,92*
11,82±2,12
24.70±10,46*
13,27 ±3,12*
1316,60 ± 229,85*
8,34 ±1,62*
0,1 10,0 (n = 9)
; f ± S D 114,29 +
18.10*
4,3710,49*
39,2618,13*
3.06 ± 0 2 8 * 83.31 ±
10,32*
11.71 ±1.77
23,72 ±9,16*
12,2513,13- 1330.60 1 213,6 8.28 12,12*
0.1 +0.0 (n = 9)
X ± S D 109,71 1
16.87*
4,28l0,5r 39,64 1 9,06*
3,0 ± 0,32*
83.89 ± 10,34*
11,1511,98*
22,4219,24*
10,70 12,72*
1378,40 ± 223,57*
7,88 ±2,22 0,09 1 0.04 (n = 9)
X ± S D 106,471
16,47*
4,2410,60*
40,51 + 9.43*
2.98 ± 0.43' 83,65 ±
11.79- 10.881
1,51*
21.42 1 8,57*
9,8612,60*
1380,10 + 259.72*
7.19 12,02 0,08 ± 0.05 (n = 5)
p < 0,05 cd y nghTa so vdi trude khi dung Dobutamin
+ Luu luang tim sau diing Dobutamin 1 gid va sau 6 gid tang so vdi trudc dung Dobutamin, cd y nghTa thong ke vdi p < 0,05.
+ Ap luc ddng mach phdi trung binh (MPAP), sirc can he thdng (SVR) d i u giam sau dimg Dobutamin.
IV. BAN LUAN
Dac diem Chung cua cac benh nhan nghiSn ciru Od tuoi trung binh 44 + 11,8 chii yeu g§p d dd tudi 40 - 60 ludi, tre nhlt la 23 tu6i, cao n h l t la 62 tuoi (bang 1), day la dSc di^m chung eua bfenh van tim t i l n tnen hau thap
Di$n tich da (BSA) = 1,43 0,13 (mm 1 , 1 4 - m a x 1,83) (bang 1), t h l p han nhilu so vdi nghidn ciru cua Manjula D va edng su
(cs) BSA = 1,85 + 0.23 [8] S u khdc biet nay do the trang ngudi Viet nam (chau A) t h l p han ngudi nudc ngoai (chau Au) va eung mdl p h l n do dac diem ton thuang van hau t h l p t i l n tnen t d tudi thilu men gay ra
Chi sd tim nguc d tat ca eac benh nhan nay d l u tang do tinh trang gian eae budng tim (bang 1) Co mdi hen quan ehat che giua phan suat tdng mau (EF) va chi sd tim nguc trdn
TCNCYH 87 (2)-2014
TAP CHI NGHIEN CU'U Y HOC • film chup nguc t h i n g . ChT sd lim n g y c cang lang thi phan s u l l ldng mau (EF) cang giam [9]
Ton thuang cang nhilu van tim nguy ca diing thudc trg tim cang Idn trong nghien eiru nay ehi cd 3 benh nhan (8,8%) sua hoac thay 1 van cd giam luu luang tim Benh nhan cd benh ly da van, suy tim lau ngay, EF thap, lim gian trudc md, thdi gian kep ddng mach ehu keo dai,,,, gdp phan lam cho tinh trang suy lim nang nd han vao giai doan sau md Royster R L va cdng s u (1991) dua ra y l u t6 d u bao dimg thude tra tim sau mo la EF t h i t trai thap, thai gian t u l n hoan ngoai ca t h l dai, thdi gian kep ddng mach chu keo dai, Idn tudi, phu nd, chi sd tim nguc Idn va dudng kinh ciia t h i l trai va/hoac nhT tren sieu am Idn [10]
Dobutamin lam tang Cl, tang luu lugng tim (CO), giam sue can he thong (SVR), giam sirc can phoi (PVR) (bang 3). Cl tang t u 1,90 + 0,29 len 2,83 ± 0,50 (51%) sau 1 gid (p < 0,05), Muc tang Cl sau 6 gid len 3,06 + 0,28 (61,58%) vdi p < 0,05. Theo Ensinger H va cdng s u (1999) lieu Dobutamin ep/kg/phiit so vdi gia d u a c thi Cl tang 46% [6] Fenck R O va edng s u (2001) eho thly Dobutamin tang Cl 56% sau 1 gid tren benh nhan sau p h l u thuat tim mach giam luu luang hm [11] Cung tuang t y theo Orellano L va cdng s y (1990) 20 benh nhan giam luu luong tim sau p h l u thuat van tim, Dobutamin vdi hlu 5 - 7 p/kg/phut, Cl tang t d 2,33 ± 0,60 lit/phiit/m^ len 2,80 ± 0,81 lit/phiit/
m^ (24,4%) sau 15 phiit d i l u tri va sau 2 gid tang len 3,52 ± 0,74 lil/phut/m^ (50%) [7].
Sii-'c can he thong (SVR) giam t u 1622,41 dynes/ses/m^ tai 1378 dynes/ses/m^ sau 1 gid, 1316,6 dynes/ses/m^ sau 6 gid vdi p < 0,05 va duy tri sau n h i l u gid (bang 2).
SVR tang nhe (1380,1 dynes/ses/m^) trong khoang 24 - 48 gid ve hdi sue lien quan tdi s y thire tinh va kich thieh (hut ndi khi quan, tap
thd") cua benh nhan trong giai doan sau mo.
Mirc tang nay trong gidi han binh thyfrng (1000 -1500 dynes/ses/m^)- Sirc can phoi (PVR) giam tir 401,16 ± 454,16 dynes/ses/m^
xudng 247,03 ± 251,77 dynes/ses/m^ sau 1 gid vdl p < 0,05, duy tri sau nhu'ng gid t i l p theo.
Theo Tarr va edng s u (1993) SVR giam dang ke (40%) [12] N h u vay, sue can ngoai bidn va sue can phdi giam tam giam hau tai thit trai, giam hau tai t h i l phai lam lang luu lugng tim, giam cdng eCia tim, giam nhu e i u oxy ca tim
H u y l t ap ddng mach trung binh tang (bang 3) t u 65,05 ± 8,97 len 79,96 ± 10,1 mmHg sau 1 gid va duy tri sau 6h d i n 48h la 83,65 ± 11,79 mmHg Tang h u y l t ap ddng mach trung binh nham dam bao ap lue t u d i mau to chirc va t u d i mau than Ap luc ddng mach ph6i trung binh giam 28,56 + 13.64 mmHg xudng 24,70 ± 10,46 mmHg sau 6 gid, Ap luc ddng mach phoi bfl (PCWP) deu giam sau 6 gicf, giam 17,52 ± 3,96 mmHg xudng 13,27 ± 3,12 mmHg (p < 0,05). Feneek R.O (2001) so sanh tac dung tren huyet ddng cua Dobutamin vdi Milrinon tren benh nhan sau p h l u thuat tim, tac gia nhan t h l y ap lye ddng mach phoi bit giam 3% [11]
Tren nhip tim lam lang t i n s6 va tang r6i loan nhip, Dobutamin tac dung true tiep len 2 thu the J3,,va (32 Thu the Pi ed d mang hau synap tren tim (ca tim, nut xoang, he th6ng dan t r u y i n trong t h i t )
Dobutamin l i l u tir 7-10 p/kg/phiJl, nhip tim tang tir 81,94 ± 13,14 nhip/phiit len 101,56 + 17,54 nhip/phiit (23,61%) sau 1 gid (p < 005) va len 112,50 ± 18,17 nhip/phut (38,63%) sau 6 gid (p < 005) (bang 2), Chung tdi ghl nhan 2 benh nhan (5,9%) cd ngoai tam thu that, sau khi da dieu chmh dien giai chung tdi phai diing cordaron de d i l u In Romson J L (1999) quan sat 100 benh nhan p h l u thuat tim vdi lilu 2,5- 40 pg/kg/phut so vdi 10 benh nhan la nh6m
TCNCYH 87 (2) - 20U
• TAP CHI NGHIEN CUTJ Y HOC chirng khdng dung Dobutamin, cho t h l y
Dobutamin la ISng nhip tim phu thugc l i l u U l u > 20 pg/kg/phut nhip tim tang tdi 85% so vdi nhip ban d l u [5]. Tac gia Feneek R.O va cpng s y (2001) nghien c u u tren 120 benh nhan giam luu luang tim dung dobutamin lam tang nhip tim len 35% so vdi 10% khi dimg Milrinon va Dobutamin eung lien quan tdi ty le mlc rung nhT mdi (18%) [11], Nhip tim lang iam tang lieu thu oxy ca tim, giam thdi gian tam truang, giam thdi gian do d l y eua t h i t Tim duac tudi mau thi tam truang nen khi giam thai gian tam truang lam giam thai gian- tudi mau ca tim, eung vdi viec lam tang lieu thu oxy CO tim thi cd the iam nang n l han thieu mau ca tim
Ca tim hoai tir phdng thfch mdt sd men vao mau trong dd cd Creatine Phosphokinase (CK) men nay tang s d m vao 2 gid, cao n h l t trong khoang 6 - 8 gid sau nhdi mau va trd lai binh thudng sau 49 - 72 gid Isoenzyme cua CK la CK - MB (Creahne Kinase - Myocardial Band) thudng d u a c sir dung vi ehuyen biet han CK, men CK - MB chi cd trong ca t'rn, nd gia tang cd y nghTa trong 95% trudng hap nhdi mau ca tim cap Theo kel qua nghien ciru cua chung tdi (bang 3) CK tir 72,38 ± 36,54 tang len 299,86 ± 232,46 (p < 0,05) va CK - MB tCr 14,13 ± 9,49 ien 49,48 ± 34,96 (p < 0,05). Tuy nhien ehua du tieu ehuan de chan doan nhdi mSu ca tim theo Hdi tim mach My
Cac tac dung phu eua Dobutamin khae theo khuyen cao ciia nha san xuat ehiing tdi khdng ghi nhan d u a c co le do ddi tuang benh nhan trong nghien ciru nay d u a c dung thudc qua catheter trung tam va p h l n Idn benh nhan flugc an t h i n thd may
V. K^T LUAN
Qua k i t qua nghien cuu 34 benh nhan cd giam luu lugng tim sau p h l u thuat van tim eo
SU' dung Dobutamin tai benh vien Tim Ha Ndi chimg tdi rut ra mdl sd k i t luan nhu sau:
Dobutamin giup cai thien huylt ddng vdi da so benh nhan giam luu luang tim sau 1 gid (25 benh nhan (74%) dap ung hoan loan vdi d i l u In b l n g Dobutamin, ed 9 benh nhan (26%) phai k i t hap vdi Noradrenalm)
Dobutamin lam tang nhip tim ed y nghTa thdng ke ngay sau khi diing va keo dai tai thai diem ngung thudc
Tang men hm (CK - MB) cd y nghTa thdng ke tuy nhien ehua du tieu ehuin c h i n doan nhdi mau ea tim ehu p h l u .
LO'I cam a n
Tdl xm Iran trang cam an GS Nguyin Thu - Nguyen chu tich Hdi Gay me - Hdi sirc Viet Nam Cac t h l y cd giao, giang vien bd mdn Gay me hdi sirc Trudng Oai hoc Y Ha Ndi Cam an ban giam doe benh vien Tim Ha Ndi da giup dd chiing tdi hoan thanh cdng trinh nay
TAI LIEU THAM KHAO 1. Andre St, Arthur C, DelRossi A (2005).
Hemodynamic management of patients m the first 24 hours after cardiac surgery Crit Care Med, 33, 2082 - 2093
2. Butterwoth J.P., Legault C , Royster R.L et al (1998). Factors that predict the use of positive inotropic drug support after cardiac valve surgery Anesth Analg, 86, 461 - 467
3. Butterwoth J (2008). Dobutamine too dangerous for "Routine" administration'? An- esthesiology. 108(6), 973 - 974
4. Fellah) J.L., Parienti J.J., Hanouz J.L., et al (2008). Perioperative use of dobutamine in cardiac surgery and adverse cardiac out- come propensity-adjusted analyses Anesthe- siology. 108(6), 9 7 9 - 9 8 7
5. Romson J . L . , Leung J.M., Bellow W.H et al (1999). Effect of dobutamine on hemody-
TCNCYH87(2)-2014
TAP CHi NGHIEN CUTJ Y HOC
namies and left ventricular performance after cardio-pulmonary bypass in cardiac surgical patients. Anesthesiology, 9 1 , 1 3 1 8 - 1328.
6. Ensinger H., Rantala A., Vogt J., et al (1999). Effect of dobutamine on splenchnie carbohydrate metabolism and ammo acid bal- ance after cardiac surgery. Anesthesiology, 9 1 , 1 5 8 7 - 1 5 9 5
7. Orellano., L, Darwisch., Ni, Dieterich HA et al (1990). Companson of dobutamine and enoximone for low output states following cardiac surgery/, 28(1), S I 3 - 9.
8. Manjula D.M: Michael A.B et al (2005).
Predictors of low cardiac output syndrome after isolated aortic valve surgery. Circulation, 112(1), 4 4 8 - 4 5 2
9. Nguyin Thy (2002). Gay me mo nhirng ngudi mang benh tim Bai giang gay me hdi sirc - tSp II - Nha xuSt ban Y hoc, 262 - 273
10. Royster R.L., Butterwoth J.F., Prough D.S (1991). Preoperative and intraop- erative predictors of inotropic support and long - term outcome in patients having coronary artery bypass grafting, Anesth. Analg, 72, 729 - 736.
11. Feneek R.O., Sherry K.M., Withing- ton P.S et al (2001). European milrinone mul- ticenter trial group Comparison of the haemo- dynamic effect of milrinone with dobutamine in patients after cardiac surgery, J, Cardiothorac Vase Anesth, 15, 306 - 315
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Summary
EVALUATION OF DOBUTAMIN EFFECTS ON HEMODYNAMIC IN LOW CARDIAC OUTPUT PATIENTS AFTER HEART VALVE REPLACEMENT
This study is aimed to evaluate the improvement of the cardiac output after surgery and the side effects of dobutamin on some hemodynamic index of patients after heart valve replacement Heart rate after 1 hour transmission of dobutamin is 101 56 + 17 54 beats per minute (bpm) in comparision with no dobutamin at 81 91 + 13 14 bpm (p < 0 05), cardiac index (Cl) is increased to 2.83 + 0 51 (l/min/m^) After 6 hours of transmission the heart rate increases to 112,50 ± 18 17 bpm in comparison with no dobutamin al 81 91 + 13.14 bpm (p < 0.05), cardiac output is in- creased to 4.38 ± 0 42 (i/min/m^) in comparison wilh 2 72 ± 0 55 (l/min/m^) before using dobuta- min (p < 0 05), cardiac index after 6 hours is 3.08 + 0,27 (l/min/m^) versus before using dobutamin 1 90 ± 0 29 (l/min/m^) (p < 0 05). Stroke volume (SV) is increased by 42 29 ± 10,52 ml versus before using dobutamin 34.59 ± 8.31 ml (p < 0.05). Dobutamin improves significantly stroite volume, cardiac output, cardiac index, decreases in lung and system resistance after using 1 hour There is a statistically significance increase of the heart rate immediately and with continous use of dobutamin until discontinuation.
Key word: low cardiac output, cardiovascular surgery, dobutamin
TCNCYH 87 (2)-20^*