右美托咪定对成人瓣膜置换术围术期心肺保护作用  

EFFECT OF DEXMEDETOMIDINE ON PERIOPERATIVE CARDIOVASCULAR PROTECTION IN ADULT VALVE REPLACEMENT

作　　者：许静红[1] 肖亮灿[2] 徐夏[1] 喻学海[1] 彭蔚[1] 杜佳楠[1] 

机构地区：[1]海南省第三人民医院麻醉科,海南三亚572000 [2]中山大学附属第一医院麻醉科

出　　处：《齐鲁医学杂志》2016年第4期414-416,共3页Medical Journal of Qilu

基　　金：广东省自然科学基金资助项目(s2012010010965)

摘　　要：目的探讨右美托咪定对成人体外循环（CPB）下心脏瓣膜置换术围术期心肺功能的影响。方法CPB下行心脏瓣膜置换术的病人50例,随机分为生理盐水组（C组）和右美托咪定组（D组）,每组25例。D组病人麻醉诱导前15min以右美托咪定1.0μg/（kg·h）恒速泵注,15min后以0.5μg/（kg·h）恒速泵注至术毕;C组病人以等速生理盐水恒速泵注,其余处理方法同D组。分别检测两组病人泵注右美托咪定或生理盐水前（T0）、CPB建立前（T1）、CPB结束后10min（T2）、手术结束时（T3）、术后12h（T4）及术后24h（T5）静脉血心肌损伤标记物心型脂肪酸结合蛋白（H-FABP）、肌酸激酶同工酶（CK-MB）和肌钙蛋白I（cTnI）浓度,以及动脉血气肺泡动脉氧梯度（AaDO_2）、氧合指数（OI）和肺内分流率（Qs/Qt）。结果 D组病人T2~T4时点H-FABP水平明显低于C组（F=52.80~122.83,P〈0.01）;T3、T4、T5时点CK-MB、cTnI水平明显低于C组（F=18.32~350.91,P〈0.01）。D组病人T2~T5时点AaDO2均明显低于C组（F=27.15~209.52,P〈0.05）;T2~T5时点OI明显高于C组（F=102.55~302.48,P〈0.01）。两组病人各时点Qs/Qt比较,差异无显著性（P〉0.05）。结论右美托咪定可以降低CPB下心脏瓣膜置换术病人围术期心肌和肺脏氧合功能的损伤。Objective To evaluate the effect of dexmedetomidine（Dex）on cardiopulmonary function in patients undergoing heart valve replacement（HVR）under extracorporeal circulation（EC）. Methods Fifty patients scheduled for HVR were evenly randomized to normal saline group（group C）and Dex group.Fifteen minutes before anesthesia induction,i.v.Dex 1.0μg/（kg·h）was given to patients in Dex group,the dose was changed to 0.5μg/（kg·h）15min later until completion of the surgery;those in the group C were given constant pumping of normal saline,other managements were the same as offered to those in Dex group D.Venous blood myocardial injury markers-H-FABP,CK-MB and cTnI-and arterial blood AaDO2,（OI）and Qs/Qt were detected in both groups,before and after pump injection of Dex or normal saline（T0）,before establishment of EC（T1）,10 min after the end of EC（T2）,at the end of the operation（T3）,and 12h（T4）and 24h（T5）after operation. Results A comparison between Dex group and group C showed as follows：at T2-T4 time points,the levels of H-FABP in Dex group were lower than that in group C（F=52.80-122.83,P〈0.01）;at T3-T5,CK-MB and cTnI in Dex group were lower（F=18.32-350.91,P〈0.01）;at T2-T5,AaDO_2 in Dex group were lower（F=27.15-209.52,P〈0.05）,and OI were higher（F=102.55-302.48,P〈0.01）.As for Qs/Qt,comparison at different time points between the two groups was not significant（P〉0.05）. Conclusion Dex can reduce injury of myocardial and lung oxygenation in patients undergoing heart valve replacement under extracorporeal circulation.

关 键 词：右美托咪定 心脏瓣膜假体植入 围手术期 肌酸激酶 肺损伤 

分 类 号：R654[医药卫生—外科学]