右美托咪定对不停跳冠状动脉搭桥术患者心肌损伤的影响  

Gffect of dexmedetomidine on off-pump coronary artery bypass grafting in patients with myocar-dial injury

作　　者：钱晓亮[1] 姚东风[1] 杨雷一[1] 程兆云[1] 

机构地区：[1]河南省人民医院心外科,郑州450008

出　　处：《中国实用医刊》2017年第2期18-20,共3页Chinese Journal of Practical Medicine

摘　　要：目的：评价右美托咪定对不停跳搭桥术患者心肌损伤的影响。方法择期行不停跳搭桥术患者60例，性别不限，年龄42~76岁，体质量51~87 kg，ASA 分级Ⅱ或Ⅲ级。采用随机数字表法，将其分为两组：对照组（C 组，30例）和右美托咪定组（D 组，30例）。麻醉诱导后气管插管，机械通气，采用静吸复合麻醉。D 组静脉输注右美托咪定0.8μg/（kg＆#183;h）至术毕，C 组给予等容量氯化钠注射液。分别于术前（T1）、术毕（T2）、术后12 h（T3）和术后24 h（T4）取静脉血样，测定血浆肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）的浓度。记录两组患者手术中的标准Ⅱ导联心电图。结果与 C 组相比，D 组 T2~ T4时血浆 TNF-α、IL-6的浓度降低（P 〈0.05），D 组 ST 段抬高平均值明显降低（P 〈0.05）。结论对于不停跳搭桥术患者术中静脉输注右美托咪定可减轻炎性反应，产生一定的心肌保护作用。Objective To evaluate the effect of dexmedetomidineon off-pump coronary artery by-pass grafting（OPCABG）in patients with myocardial injury. Methods Sixty ASA physical status II orⅢ patients of no gender limitation,aged 42 - 76 years,weighing 51 - 87 kg,scheduled for elective total correction of coronary disease under off-pump,were randomly divided into two groups：control group （group C,30 each）and dexmedetomidine group（group D,30 each）. The patients were endotracheally intubated and mechanically ventilated. After intubation,dexmedetomidine was infused intravenously at 0. 8 μg /（kg＆#183;h）until the end of operation in group D,while the equal volume normal saline was given instead of dexmedetomidine in group C. Venous blood samples were obtained before operation（T1）,at the end of operation（T2）,12 h after operation（T3）and 24 h after operation（T4）for determination of plasma TNF-α and IL-6 concentrations. The two groups of patients with surgery of standardⅡlead electro-cardiogram（ECG）were recorded. Results The concentrations of plasma TNF-α and IL-6 were signifi-cantly lower at the time of T2-T4 in group D than those in group C（P 〈 0. 05）. The average level of ele-vated ST（MST）had statistical significance（P 〈 0. 05）. Conclusions For the patients undergoing total correction of coronary disease under off-pump,dexmedetomidine infused at 0. 8 μg /（kg＆#183;h）during op-eration can exert myocardial protective effect with clinical significance.

关 键 词：右美托咪啶 冠状动脉旁路移植术 非体外循环 心肌保护 

分 类 号：R654.2[医药卫生—外科学]