术中持续泵注右美托咪定对老年腹腔镜下胃肠癌根治术患者的心肌保护作用  

Myocardial protective effects of intraoperative continuous infusion of dexmedetomidine in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer

作　　者：王青青 尹治清[1] 袁振飞[1] 

机构地区：[1]南通瑞慈医院麻醉科,江苏南通226010

出　　处：《吉林医学》2018年第1期45-49,共5页Jilin Medical Journal

摘　　要：目的:研究术中持续泵注右美托咪定对老年腹腔镜胃肠癌根治术患者的心肌保护作用。方法:选择择期行腹腔镜胃肠癌根治术患者70例,男40例,女30例,年龄65~81岁,体重45~80kg,ASAⅠ~Ⅱ级,随机分为两组:右美托咪定组(D组)和对照组(C组),每组35例。D组插管前1μg/kg缓慢静脉滴注右美托咪定,输注时间超过10min,并于术中持续泵注右美托咪定0.5μg/(kg·h)至手术结束前30min;C组以生理盐水替代盐酸右美托咪定。两组麻醉诱导和维持方法相同。记录麻醉诱导前(T0)、气管插管后即刻(T_1)、气腹建立即刻(T_2)、手术结束时(T_3)、拔管即刻(T_4)及拔管后30min(T5)的血流动力学指标:包括平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO_2)、呼气末二氧化碳分压(PETCO_2)。记录T0及术后12h(T6)、48h(T7)心肌酶学指标[包括血清肌钙蛋白(cTnI)、乳酸脱氢酶(LDH)和肌酸激酶同工酶(CK-MB)的浓度。]记录围术期和术后3个月相关不良事件发生情况。结果:两组患者T0~T5时的SpO_2及PETCO_2比较,差异均无统计学意义(P>0.05)。与T0时比较,两组MAP明显降低,差异有统计学意义(P<0.05)。D组T_1~T5时段MAP、HR波动较C组波动明显小,差异有统计学意义(P<0.05);D组在T_1、T_2、T_4时HR明显低于NS组,差异有统计学意义(P<0.05)。与T0时比较,T6、T7两组cTnI、CK-MB水平明显升高,差异有统计学意义(P<0.05);与T0时比较,T6、T7时两组LDH水平差异无统计学意义(P>0.05)。D组在T6、T7时cTnI、CK-MB水平明显低于C组(P<0.05)。围术期及术后随访3个月,两组均无一例心脑血管意外等不良事件发生。结论:术中持续泵注右美托咪定0.5μg/(kg·h)应用于术前无明显心肌损伤的老年腹腔镜胃肠癌根治术的患者具有减轻围术期患者心肌损伤的作用,并可稳定血流动力学。Objective To investigate the myocardial protection of intraoperative continuous infusion of dexmedetomidine in elderly patients undergoing laparoscopic surgery. Method Seventy patients with ASA Ⅰ - Ⅱ,forty males and thirty females,aged65 - 81 years,weighing 45 - 80 kg,undergoing selective general anesthesia laparoscopic resection of gastrointestinal cancer were randomly divided into dexmedetomidine group（group D） and control group（group C） with 35 cases each. In group D,dexmedetomidine was administered intravenously at 0. 5 μg/（kg·h） after a bolus infusion at 1 μg/kg over 10 minutes before anesthesia induction until 30 minutes before the completion of surgery. Group C was administered saline instead. The medications and methods of anesthesia induction in the two groups were identical. MAP,HR,SpO2 and PETCO2 were recorded before intubation（T0）,intubation（T1）,pneumoperitoneum（T2）,the end of surgery（T3）,extubation（T4） and 30 minutes afterextubation（T5）.Meanwhile,changes of serum cardiac troponin I（c Tn I）,lactate dehydrogenase（LDH） and creatine phosphokinase isoenzyme（CK-MB） at T0,12 h（T6）,48 h（T7） after operation were also observed. Adverse cardiovascular event happended during perioperation and 3 months following up was recorded. Results There were no significant differences in SpO2 and PETCO2 between T0- T5（P〈0. 05）. Compared with T0,the two groups of MAP significantly decreased（P〈0. 05）. The fluctuation of MAP and HR in group D was significantly lower than group C at T1- T5（P〈0. 05）. HR at T1,T2,T4 in group D was obviously lower compared with group C（P〈0. 05）. Compared with T0,the levels of c Tn I and CK-MB in T6 and T7 were significantly increased（P〈0. 05）. There was no significantly difference in the serum levels of LDH between two groups at T6 and T7 copmpared with T0（P〈0. 05）. The fluctuation of c Tn T and CK-MB in group D was significantly lower than group C at T6 and T7（P〈0. 05）. No major adverse cardio

关 键 词：右美托咪定 心肌保护作用 老年 腹腔镜手术 胃肠癌根治术 

分 类 号：R614[医药卫生—麻醉学] R735[医药卫生—外科学]