右美托咪定对瓣膜置换患者围术期心肌保护和血流动力学的影响  

Effect of Dexmedetomidine on Myocardium Protection and Hemodynamics in Patients Undergoing Heart Valve Replacement During Peri-Operative Period

作　　者：何江[1] 孙海云[2] 蔡珺[3] 

机构地区：[1]清远市人民医院麻醉科,广东清远511500 [2]广东省人民医院心血管病研究所麻醉科,广东广州510080 [3]中山大学第三附属医院麻醉科,广东广州510630

出　　处：《临床医学工程》2017年第6期785-787,共3页Clinical Medicine & Engineering

摘　　要：目的观察右美托咪定对体外循环下瓣膜置换患者围术期心肌保护以及血流动力学的影响。方法选择50例择期行瓣膜置换术患者,ASAⅡ~Ⅲ级,年龄18~64岁,使用随机法分为对照组(C组,n=25)和右美托咪定组(D组,n=25)。D组麻醉诱导前静脉泵注右美托咪定负荷剂量0.5μg/kg,15 min输注完毕,随后以0.5μg·kg-1·h-1速率泵注至术毕。C组采用同样方法静脉泵注等容量生理盐水。分别于入室(T_0)、右美托咪定负荷量泵注完毕(T_1)、气管插管后1 min(T_2)、切皮后(T_3)、劈胸骨后(T_4)、停CPB后(T_5)、术毕(T_6)记录血流动力学参数,于T_0、T_5、T_6及术后6 h(T_7)、24 h(T_8)抽取中心静脉血测定血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)活性及心肌肌钙蛋白I(cTnI)浓度,并观察自动复跳情况和术后ICU期间心律失常发生率。记录呼吸机辅助时间和停留ICU时间。结果与C组比较,D组T_1~T_4的HR减慢,MAP明显下降(P<0.05)。与T_0相比,两组T_5~T_8的血清CK、CK-MB活性及cTnI浓度均升高(P<0.05),两组间比较,D组CK、CK-MB及cTnI升高梯度明显低于对照组(P<0.05)。开放主动脉后D组自动复跳率及术后ICU期间心律失常发生率与C组相比差异无统计学意义(P>0.05)。D组术后呼吸机辅助时间和停留ICU时间均显著少于C组(P<0.05)。结论右美托咪定应用于瓣膜置换患者,可维持围术期血流动力学稳定,具有心肌保护作用。Objective To evaluate the effect of dexmedetomidine on myocardium protection and hemodynamics in patients undergoing heart valve replacement during peri-operative period. Methods Fifty ASA I/ or III patients aged from 18 to 64 undergoing heart valve replacement were randomly divided into dexmedetomidine group （group D, n = 25） and control group （group C, n = 25）. In group D, dexmedetomidine was administered intravenously at 0.5μg-kg-1· h-1 after a bolus infusion at 0.5μg/kg for 15 rain before anesthesia, while the same volume of normal saline were given in group C. Hemodynamic parameters were measured before injection （T0）, after administration （T1）, at intubation （T2）, after incision （T3）, after stermum saw （T4）, after CPB （Ts） and immediately after surgey （T6）. The central venous blood samples were collected in both groups at T0, T5, T6, 6 h after operation （TT）, 24 h after operation （T8） for detecting the plasma creatine kinase （CK）, creating kinase-MB （CK-MB） activity and cardiac treponin I （cTnI） concentration. Automatic recovery rate of heart beats after cardiac resuscitation, postoperative incidence of arrhythmia during ICU staying, the time of mechanical ventilation and the time of staying in ICU were recorded. Results Compared with the group C, the HR and MAP were significantly lower in group D at T1 - T4 （P〈0.05）. Compared with the baseline value at T0, the plasma CK, CK-MB activity and eTnI concentration were significantly increased at T5 - T8 in two groups （P〈0.05）, but compared between the two groups, the plasma CK, CK-MB activity and cTnI concentration in group D were significantly lower than those in group C at T5 - T9 （P 〈0.05）. The automatic recovery rate of heart beats after cardiac resuscitation and incidence of arrhythmia during ICU staying had no significant difference between two groups （P〉0.05）. The time of mechanical ventilation and the time of staying in ICU in group D were significantly shorter than those

关 键 词：右美托咪定 瓣膜置换 心肌保护 血流动力学 

分 类 号：R614[医药卫生—麻醉学]