右美托咪定在经皮左心耳封堵术中的应用  

Application of Dexmedetomidine in percutaneous left atrial appendage occlusion

作　　者：郑君刚[1] 王伟飞[2] 曹刚[1] 钱幸尔 陈勇杰[1] 王冠军[3] 郁一波[3] 卢子会[1] 黄长顺[1] ZHENG Jungang WANG Weifei CAO Gan QIAN Xing＇er CHEN Yongjie WANG Guanjun YOU Yibo LU Zihui HUANG Changshun(Department of Anesthesiology, Ningbo First Hospital, Ningbo 315010, China Department of Acupuncture and Mox- ibustion, Ningbo First Hospital, Ningbo 315010, China Department of Cardiology, Ningbo First Hospital, Ningbo 315010, China)

机构地区：[1]宁波市第一医院麻醉科,浙江宁波315010 [2]宁波市第一医院针灸科,浙江宁波315010 [3]宁波市第一医院心内科,浙江宁波315010

出　　处：《中国现代医生》2016年第35期110-114,共5页China Modern Doctor

基　　金：浙江省医学会临床科研基金项目(2015ZYC-A51)

摘　　要：目的 拟评价右美托咪定在经皮左心耳封堵术中的应用价值。方法 选取非瓣膜性房颤卒中危险评分（CHA2DS2-VAS评分）≥2分拟行经皮左心耳封堵术的房颤患者80例,ASA分级Ⅱ或Ⅲ级,NYHA分级Ⅱ或Ⅲ级,应用随机数字表法将患者分为对照组（C组）和右美托咪定组（D组）,每组40例。D组全身麻醉诱导插管前10 min静脉泵注右美托咪定负荷剂量0.5-1.0μg/kg,随后以0.4μg/（kg·h）的速率维持至术毕,C组予等容量生理盐水作对照,两组术中维持BIS值40-60。于给药前、术后6 h、术后48 h取血样,测血清肌钙蛋白I（cTnI）的浓度。入室后（T0）、气管插管即刻（T1）、经食道超声探头（TEE）置入即刻（T2）、封堵器放置即刻（T3）及拔除气管导管即刻（T4）记录收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）及心率（HR）,同时记录术中封堵器一次性释放到位率、心血管不良反应的发生率情况、总手术时间及住院时间。结果 与C组比较,D组术后6 h、48 h血清cTnI的浓度明显降低（P〈0.05）,D组患者围术期血流动力学指标更平稳,术中封堵器一次性释放到位率明显高于C组（P〈0.05）,心血管不良反应的发生率更低（P〈0.05）,两组患者的总手术时间及住院时间比较无明显差异。结论 右美托咪定的应用对经皮左心耳封堵术患者心肌损伤起到一定的保护作用,更有利于维持患者血流动力学的平稳,减少术中心血管不良反应的发生率,便于术者介入手术操作。Objective To evaluate the application value of dexmedetomidine in percutaneous left atrial appendage occulsion. Methods 80 patients with atrial fibrillation whose risk score of nonvalvular atrial fibrillation and stroke （CHA2DS2-VAS score） was ≥ 2 and who were proposed to be given percutaneous left atrial appendage occulsion were selected. The ASA grade was II or III, and NYHA grade was II or III. The patients were divided into two groups according to the random number table： control group （group C） and dexmedetomidine group （group D）, with 40 patients in each group. Group D was intravenously injected with dexmedetomidine load dose of 0.5-1.0 μg/kg 10 min before general anesthesia induced intubation, followed by the injection with 0.4 μg/（kg·h） rate until the end of the surgery. Group C was given normal saline with equal volume for the control. In the two groups, the ~IS value was maintained at 40-60 during the Surgery. Blood samples were taken before administration, at 6 hours and 48 hours after operation, and the concentration of serum troponin I （cTnI） was measured. Systolic blood pressure（SBP）, diastolic blood pressure （DBP）, mean arterial pressure （MAP） and heart rate （HR） were recorded upon entering the surgery room （T0）, upon tracheal intubation （T1）, upon placement of transesophageal ultrasound probe （TEE） （T2）, upon placement of occluder （T3） and upon extubation （T4）. At the same time, the rate of one-off re/ease in place by the occluder during the surgery, the incidence of cardiovascular adverse events, the total operation time and the length of stay were recorded. Results Compared with group C, serum levels of cTnI concentration were significantly decreased at 6 and 48 hours after the surgery in group D （P〈0.05）. The perioperative hemodynamic indicators were more stable in group D, and the rate of one-off release in place by occluder was significantly higher than that in group C （P〈0.05）. The incidence of cardiovascular adve

关 键 词：右美托咪定 经皮左心耳封堵 房颤 心肌 

分 类 号：R541.75[医药卫生—心血管疾病]