右美托咪定对老年高血压患者围术期心肌的保护作用  

The protective effect of dexmedetomidine on perioperative myocardial injury in aged hypertensive patients

作　　者：顾国华[1] 冯兆明[1] 朱俊峰[1] 

机构地区：[1]上海交通大学附属第六人民医院金山分院麻醉科,201500

出　　处：《临床麻醉学杂志》2011年第8期797-799,共3页Journal of Clinical Anesthesiology

摘　　要：目的观察右美托咪定对老年高血压患者围术期心肌的保护作用。方法择期行全髋置换术的老年高血压患者60例,年龄>65岁,ASAⅡ或Ⅲ级,高血压Ⅱ级,随机均分为右美托咪定组(D组)和对照组(C组)。D组在麻醉诱导前给予负荷剂量右美托咪定1μg/kg,泵注时间超过10 min,以0.7μg.kg-1.h-1持续静脉注射。记录麻醉前10 min、气管插管后即刻、拔管后即刻患者的BP、HR及ECG ST段改变。于麻醉前10 min(T0)、手术开始后1 h(T1)、术毕(T2)、术后12 h(T3)、24 h(T4)抽取中心静脉血,采用ACB法测定缺血修饰白蛋白(IMA)水平。结果气管插管后即刻、拔管后即刻D组HR明显慢于C组,SBP、DBP明显低于C组(P<0.05)。C组有7例患者ST段出现心肌缺血性改变,明显多于D组的1例(P<0.05)。T1、T2时C组IMA水平显著升高,且明显高于D组(P<0.05)。结论静脉注射右美托咪定能减轻老年高血压患者围术期心肌损伤,对心肌有一定保护作用。Objective To determine the protective effect of dexmedetomidine on perioperative myocardial injury in aged hypertensive patients. Methods Sixty patients with hypertension of Ⅱ degree, aged 〉 65 year, undergoing hip replacement surgery were randomly divided into dexmedetomidine group （D） and control group （C） with 30 cases each., In group D, dexmedetomidine was administered intravenously at 0.7 μg · kg^-1 · h^-1 after a bolus infusion at 1 μg/kg for 10 min before anesthesia induction. Changes of HR, SBP, DBP and ST segment in ECG were monitored 10 minutes before anesthesia, immediately after intubation and extubation. The central venous blood samples were obtained to measure the expression of IMA （ischemia modified albumin） 10 minutes before anesthesia （T0）, lh after skin incision （T1） ,at the end of operation （T2） and 12 h, 24 h after operation （T3-4） in cobalt binding （ACB） test. Results HR, SBP, DBP in group D was lower than that of group C immediately after intubation and extubatiom The cases with ST segment changes showing myocardial injury were significantly higher in group D than those in group C （7 VS 1） （P〈0. 05）. The expression of IMA in group C at T1 ,T2 were obviously higher than that of group D （P 〈 0. 05）. Conclusion Dexmedetomidine intravenously could attenuate the degree of myocardial damage in aged hypertensive patients undergoing hip replacement surgery.

关 键 词：右美托咪定 高血压 老年 心肌保护 

分 类 号：R614[医药卫生—麻醉学]