右美托咪定对非体外冠脉搭桥术患者的心肌保护作用  

MYOCARDIAL PROTECTION EFFECT OF DEXMEDETOMIDINE IN PATIENTS UNDERGOING OFFPUMP CORONARY ARTERY BYPASS GRAFT SURGERY

作　　者：靳彦涛[1] 徐莉莉 张岚[1] 徐凯智[1] 

机构地区：[1]河北医科大学唐山工人医院麻醉科,河北省唐山市063000 [2]唐山市弘慈医院麻醉科

出　　处：《中国煤炭工业医学杂志》2017年第11期1350-1353,共4页Chinese Journal of Coal Industry Medicine

摘　　要：目的观察右美托咪定(Dex)对非体外循环冠状动脉搭桥术(OPCABG)患者的心肌保护作用。方法选取择期行OPCABG患者60例(ASAⅡ~Ⅲ级),随机分为右美托咪定组(观察组)和对照组各30例。两组麻醉诱导药物相同,观察组于入室后输注Dex负荷剂量1.0μg/kg,继以0.5μg/kg/h的速率维持至术毕,对照组用相同方式输注生理盐水。分别于入室后10min(T0)、手术开始(T1)、术毕5min时(T2)及术毕12h(T3),抽取中心静脉血3ml离心分离血清,采用双抗体夹心-酶联免疫分析(ELISA)法定量测定血清中TNF-α、IL-6、IL-10以及cTnI的含量。结果 TNF-α、IL-6和cTnI在T0和T1时点观察和对照两组比较差异无统计学意义(P>0.05),在T1时点观察组的IL-10水平高于对照组(P<0.05)。在T2和T3时点观察组TNF-α和cTnI的水平均低于对照组(P<0.01),观察组IL-10水平均高于对照组(P<0.01)。观察组IL-6水平分别低于对照组(P<0.01和P<0.05)。结论右美托咪定通过减弱炎症反应和增强抗炎症反应,减轻OPCABG患者的心肌组织损伤,对心肌起到一定的保护作用。Objective To study the myocardial protection effect of dexmedetomidine in patients undergoing off - pump coronary artery bypass graft surgery （OPCABG）.Methods Sixty patients （ASA Ⅱ ~ Ⅲ ） undergo- ing OPCABG were randomly divided into two groups ： dexmedetomidine group （ n = 30 ） and the control group （n = 30）.The same drugs of anesthetic induction were treated in two groups.Dexmedetomidine was given at a loading dose of 1.0 μg/kg to patients in group D,and then infused continuously at a rate of 0.5μg/（kg.h） .The same programme infusion of saline was given in group C,3ml venous blood specimen were taken for separa- ting serum at 10 min after entering the operation room （TO）, the beginning of the operation （T1）, 5 min after the operation （T2} and 12h after the operation （T3） ,and then the double antibodies sandwich- enzymelinked immunosorbent assay （ELISA） was conducted to detecte the content of TNF-α,IL- 6, IL- 10 and cTnI in serum.Results At TO and TI, there were not significant difference in the concentrations of TNF- α, IL- 6 and cTnI in serum between the two groups （P^0.05） ,and the concentration of IL- 10 in serum of group D was significantly higher than group C at T1 （P〈0.05）.At T2 and T3, the concentration of TNF- α and eTnI in serum of group D were extremely significantly lower than group C （P〈0.01）, the concentration of IL- 10 in serum of group D were extremely significantly higher than group C （P〈0.01）, the concentration of IL-6 in serum of group D were respectively extremely significantly （P 〈0.01 ） and significantly （P 〈0.05 ） lower than group C.Conclusion Dexmedetomidine can decrease the inflammation responses and enhancing the anti -inflammatory responses caused by OPCABG,reduce the myocardial injury and improve the cardiac function of the patients.

关 键 词：右美托咪定 非体外循环冠状动脉搭桥术 心肌保护 

分 类 号：R654.2[医药卫生—外科学]