右旋美托咪定联合美托洛尔治疗蛛网膜下腔出血并心肌损伤的研究  

Therapeutic effects of dexmedetomidine combined metoprolol on subarachnoid hemorrhage complicated myocardial injury

作　　者：方志成[1] 郑翔[1] 张浩明[1] 陈黎[1] 

机构地区：[1]湖北医药学院附属太和医院重症医学科,湖北十堰442000

出　　处：《心血管康复医学杂志》2016年第6期599-604,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：湖北省自然科学基金项目(2014CFB314)~~

摘　　要：目的:观察右旋美托咪定联合美托洛尔治疗蛛网膜下腔出血并心肌损伤的疗效。方法:131例蛛网膜下腔出血并心肌损伤患者按照随机数字法被分为对照组(31例)、美托洛尔组(34例)、右旋美托咪定组(32例)、右旋美托咪定与美托洛尔联合治疗组(34例),测定各组血浆去甲肾上腺素(NE)、肾上腺素(E),脑利钠肽(BNP)、心肌肌钙蛋白I(cTnI)水平、并行心脏超声等评估治疗前后心肌损伤恢复情况。结果:与术前比较,美托洛尔、右旋美托咪定和联合治疗组术后1dLVEDd明显增加,术后3d开始明显减小,术后7d恢复到术前水平(P均<0.05);LVEF术后1d明显降低,术后3d开始明显提高,术后7d恢复到术前水平(P均<0.05);cTnI、BNP、NE和E水平术后1d明显升高,术后3d开始降低,术后7d恢复到术前水平(P均<0.05);术后7d,与对照组、美托洛尔组、右旋美托咪定组比较,联合治疗组LVEDd明显减小,LVEF明显提高,心功能明显改善;血浆NE[(1.37±0.08)pmol/L、(1.05±0.09)pmol/L、(1.19±0.07)pmol/L比(1.01±0.06)pmol/L]、E[(6.17±0.41)pmol/L、(6.02±0.34)pmol/L、(6.06±0.29)pmol/L比(5.26±0.26)pmol/L],cTnI[(0.22±0.02)μg/L、(0.11±0.03)μg/L、(0.17±0.02)μg/L比(0.09±0.01)μg/L]、BNP[(1126.81±11.27)ng/L、(1014.09±14.29)ng/L、(1154.09±16.52)ng/L比(954.09±9.31)ng/L]水平明显降低(P均<0.05)。结论:右旋美托咪定、美托洛尔及其两者联合治疗均可有效抑制蛛网膜下腔出血并心肌损伤,改善心功能,但联合治疗效果最好。Objective： To observe therapeutic effects of dexmedetomidine combined metoprolol on subarachnoid hemorrhage （SAH） complicated myocardial injury （MI）. Methods： According to random number table, a total of 131 SAH ＋ MI pa- tients were divided into control group （n = 31）, metoprolol group （n = 34）, dexmedetomidine group （n = 32） and combined treatment group （n = 34, received metoprolol combined dexmedetomidine）. Plasma levels of norepinephrine （NE）, epi- nephrine （E）, brain natriuretic peptide （BNP） and cardiac troponin I （cTnI） were measured, echocardiography etc. were used to assess MI recovery condition before and after treatment in all groups. Results： Compared with before operation, there was significant rise in LVEDd on ld after operation, significantly reduced on 3d after operation and recovered to nor- mal on 7d after operation （P〈0.05 all） ; significant reduction in LVEF on ld after operation, significantly rose on 3d after operation and recovered to normal on 7d after operation （P〈0.05 all） ; significant rise in levels of cTnI, BNP, NE and E on ld after operation, started to reduce on 3d after operation and recovered to normal on 7d after operation in metoprolol group, dexmedetomidine group and combined treatment group, P〈0. 05 all; compared with control group, metoprolol group and dexmedetomidine group on 7d after operation, there was significant reduction in LVEDd, and significant rise in LVEF and significant improvement in cardiac function; significant reductions in plasma levels of NE [ （1.37 ± 0.08） pmol/ L, （1.05 ± 0. 09） pmol/L, （1.19 ± 0.07） pmol/L vs. （1.01 ± 0. 06） pmol/L], E [ （6. 17 ± 0. 41） pmol/L, （6. 02±0.34） pmol/L, （6. 06± 0. 29） pmol/L vs. （5. 26± 0. 26） pmol/L], cTnI [ （0.22± 0.02） μg/L, （0. 11 ± 0.03） μg/L, （0. 17±0.02） μg/L vs. （0. 09 ± 0. 01） μg/L] and BNP [ （1126. 81±11.27） ng/L, （1014. 09 ± 14. 29） ng/L, （1154. 09 ± 16. 52） ng/L vs. （954. 09

关 键 词：蛛网膜下腔出血 心肌缺血 美托洛尔 右旋美托咪定 

分 类 号：R542.72[医药卫生—心血管疾病]