Effects Of Oral Nicorandil On Pulmonary Hemodynamics In Rheumatic Heart Disease With Phlmonary Hypertension Undergoing Cardiac Valve Replacement By Cardiopulmulnary Bypass

Objective:To evaluated the effects of nicorandil on hemodynamics in rheumatic heart disease patients with pulmonary hypertension undergoing valvular heart surgery during cardiopulmonary bypass(CPB).Methods:Patients with mean pulmonary arterial pressures (MPAP)greater than 30mmHg were eventually ineluded in this study before surgery. Thirth cases were randomly divided into the control group(n=15)and the experimental group(n=15).Each patient in the experimental group was given 10mg nicorandil(orally) when going to the operating room, In control group,patients were not given nicorandil.Hemodynamice variables were measured after Swan-Ganz was inserted,at the menment of T0(after Swan-Ganz was inserted), T1(20min after medication),T2(40min after medication),T3(before bypass), T4(30min after CPB),T5(2h after CPB),T6(4h after CPB).Record the date of CVP,MPAP,PCWP,CO,CI,SVI,SVR,PVR at T0,T1,T2,T3,T4,T5,T6.Results:1.In experimental group,the MPAP and MPAP/MAP was significanily lowered at T1,T2,T3(T1,T2, P<0.05; T3, P<0.01).And compared with the control group,the MPAP and MPAP/MAP was significanily reduced(P<0.05) in the experimental group. The MAP of the two groups was significanily lowered at Tl,T2,T3(T1,T2, P<0.05; T3, P<0.01).The HR of the two groups had a significanily increased(P<0.05)similarly.And compared with the control group,the PWCP was significanily reduced (P<0.05)at T4.In two group,the CVP was significanily lowered(P<0.05)atT4,T5,T6.Both the CO,CI of two groups were signifieantly increased(P<0.05) after CPB. The SVR of the two groups was lowered sligtly. In experimental group,the PVR was significanily lowered at T2,T3,T5,T6(T2,T3, P<0.01,T5,T6,P<0.05) and compared with the control group,the PVR was significanily reduced(P<0.05) at T2, T3.2. The dosagy of sodium nitroprussiate in the experimental group were significantly lowered than the control group (P<0.05).Conclusion:Nicorandil produced significant pulmonary vasodilatory effect in cardiac surgical patients with pulmonary hypertension and improved the hemodynamics of patients undergoing heart valve replcement.