右美托咪定在老年患者非体外循环冠状动脉旁路移植术中的心肌保护作用  

Protection of Dexmedetomidine on Cardiac Muscle of Elderly Patients with OPCABG

作　　者：郑智文[1] 崔丹[2] 李海燕[1] 谢志强[1] 陈杰[1] 

机构地区：[1]唐山市人民医院麻醉科,河北唐山063000 [2]唐山市人民医院ICU,河北唐山063000

出　　处：《中国药房》2016年第20期2836-2838,共3页China Pharmacy

摘　　要：目的：探讨右托咪定在老年患者非体外循环冠状动脉旁路移植术（OPCABG）中的心肌保护作用及安全性。方法：选取拟行OPCABG的老年患者50例,按随机数字表法分为观察组和对照组,各25例。两组患者术前30 min均肌内注射吗啡0.2 mg/kg＋东莨菪碱0.3 mg/kg,采用舒芬太尼1μg/kg＋依托咪酯0.1~0.2 mg/kg＋哌库溴铵0.1 mg/kg进行诱导麻醉。然后,观察组给予盐酸右美托咪定注射液1μg/kg,ivgtt,15 min完成,然后以0.5μg/（kg·h）微泵输注至手术结束;对照组患者给予等量0.9%氯化钠注射液,ivgtt。观察两组患者入室后（T_1）、血管吻合完毕后（T_2）及术后6 h（T_3）、12 h（T_4）、24 h（T_5）时点的肌钙蛋白Ⅰ（cT_nⅠ）、缺血修饰白蛋白（IMA）、超氧化物歧化酶（SOD）、丙二醛（MDA）水平和不良反应发生情况。结果：观察组患者T_2、T_3、T_4时点的IMA显著低于对照组,T_2、T_3、T_4、T_5时点的c T_nⅠ显著低于对照组,差异有统计学意义（P〈0.05）。两组患者T_1、T_2、T_3、T_4、T_5时点SOD水平比较,差异均无统计学意义（P〉0.05）,两组患者T_4、T_5时点血清中MDA水平显著降低,且观察组显著低于对照组,差异均有统计学意义（P〈0.05）。两组患者均未见明显不良反应发生。结论：右托咪定对老年OPCABG患者心肌具有一定保护作用,能减轻患者心肌的损伤,且安全性较好。OBJECTIVE ： To investigate the cardiac-protective effects and safety of dexmedetomidine on cardiac muscle of elder- ly patients with non-coronary artery bypass grafting （OPCABG）. METHODS： 50 elderly patients underwent OPCABG were selected and randomly divided into observation group and control group, with 25 cases in each group. Both groups received mor- phine 0.2 mg/kg＋scopolamine 0.3 mg/kg intramuscularly 30 min before operation, and were given sulfentanyl 1 μg/kg＋etomidate 0.1-0.2 mg/kg＋pipecurium bromide 0.1 mg/kg for anesthesia induction. Observation group was given Dexmedetomine hydrochloride injection 1 μg/kg, ivgtt, within 15 min, and then by pump injection at 0.5 μg/（kg· h） till the end of operation; control group was given constant volume of 0.9% Sodium chloride injection, ivgtt, cTn I , IMA, SOD and MDA levels and the occurrence of ADR were observed in 2 groups after entering the operation room （T1）, at the end of vascular anastomosis （T2）, 6 （T3）, 12 （T4）, 24 h （T5） after operation. RESULTS： IMA of observation group at T2, T3 and T4 were significantly lower than those of control group, and cYnl at T2, T3, T4, and T5 were significantly lower than those of control group, with statistical significance （P〈0.05）. There was no statistical significance in SOD level at T1, T2, T3, T4, and T5 between 2 groups （P〉0.05）. Serum level of MDA in 2 groups at T4, and T5 were decreased significantly, and the observation group was lower than the control group, with statistical significance （P〈0.05）. No obvious ADR was found in 2 groups. CONCLUSIONS： Dexmedetomidine can protect cardiac muscle of elderly patients with OPCABG to certain extent, and relieve myocardial injury with good safety.

关 键 词：非体外循环冠状动脉旁路移植术 右美托咪定 心肌保护 老年患者 

分 类 号：R614.21[医药卫生—麻醉学]