右旋美托咪定对高血压患者手术期心肌保护作用的初步研究  

A Preliminary Study on the Intraoperative Myocardial Protection Effect of Dexmedetomidine in Patients with Hypertension

作　　者：张弩[1] 徐威[1] 刘丽[1] 

机构地区：[1]复旦大学附属金山医院麻醉科,上海201508

出　　处：《中国临床医学》2014年第6期671-673,共3页Chinese Journal of Clinical Medicine

基　　金：上海市金山区科委资助项目(编号:2011-3-14)

摘　　要：目的：探讨右旋美托咪定对高血压患者手术期心肌损伤是否有保护作用。方法：选择60例接受择期手术的高血压患者,美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级Ⅰ~Ⅱ级,年龄22~60岁,体质量指数19~26 kg/m2。将60例患者随机分为右旋美托咪定组和对照组,每组各30例。右旋美托咪定组静脉泵注右旋美托咪定负荷剂量0.5μg/kg（手术开始前10 min）,继之以0.2μg/（kg·h）维持至手术结束前30 min;对照组静脉泵注0.9%氯化钠液。麻醉诱导前和术后6 h、24 h抽取静脉血,测定血清心肌肌钙蛋白I（cardiac troponin I,cTnI）、白细胞介素6（interleukin 6,IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）的浓度。结果：对照组术后6 h、24 h时cTnI、IL-6、TNF-α浓度与麻醉诱导前比较差异均有统计学意义（P〈0.05）,右旋美托咪定组术后24 h时IL-6浓度、术后6 h和24 h时TNF-α浓度与麻醉诱导前比较差异均有统计学意义（P〈0.05）。右旋美托咪定组术后6、24 h cTnI、IL-6、TNF-α浓度均低于对照组（P〈0.05）。结论：右旋美托咪定对高血压患者手术期的心肌损伤有一定的保护作用。Objective：To explore whether there was intraoperative myocardial protection effect of dexmedetomidine in patients with hypertension.Methods：A total of 60 patients with hypertension undergoing elective abdominal surgery,who were classified asⅠ-Ⅱ according to American Society of Anesthesiologists（ASA）criteria and aged 22-60 years old with body mass index（BMI）19-26 kg/m2,were randomly divided into dexmedetomidine group and control group,with 30 cases in each group.Patients in dexmedetomidine group were given a loading dose of dexmedetomidine 0.5μg/kg（10 min before the operation）which was followed by a continuous infusion of 0.2μg/（kg·h）till 30 minutes before the end of operation.Patients in the control group were intravenously pumped 0.9% sodium chloride solution.The serum concentration of cardiac troponin I（cTnI）,interleukin 6（IL-6）and tumor necrosis factor-α（TNF-α）were measured before anesthesia induction and at 6h and 24 h after operation.Results：There were significant differences in cTnI,IL-6 and TNF-αin control group at 6 h and 24 h after operation compared with those before anesthesia induction（P〈0.05）.There were significant differences in IL-6 at 24 h after operation and TNF-αat 6 h and 24 h after operation in dexmedetomidine group compared with those before anesthesia induction（P〈0.05）.The concentration of cTnI,IL-6 and TNF-αin dexmedetomidine group were significantly lower than those in the control group at 6 h and 24 h after operation（P〈0.05）.Conclusions：There was certain intraoperative myocardial protection effect of dexmedetomidine in patients with hypertension.

关 键 词：右旋美托咪定 高血压 心肌保护 

分 类 号：R544.1[医药卫生—心血管疾病]