右美托咪定对接受PCI治疗的AMI患者冠脉和心肌保护的影响  

Influence of dexmedetomidine on coronary artery and myocardial protection in AMI patients undergoing PCI

作　　者：韩利锋[1] 贺晓丹[1] HAN Li-feng; HE Xiao-dan(Department of Anesthesiology, First Hospital of Yulin City, Yulin, Shaanxi, 719000, China)

机构地区：[1]陕西省榆林市第一医院麻醉科,陕西榆林719000

出　　处：《心血管康复医学杂志》2018年第5期576-580,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨右美托咪定对接受经皮冠状动脉介入(PCI)治疗的急性心肌梗死(AMI)患者冠脉和心肌保护的影响。方法:选择2016年3月～2017年3月于我院行PCI术的92例AMI患者为研究对象。患者被随机均分为常规PCI组和右美托咪定组(在常规PCI组基础上静脉泵注右美托咪定)。观察比较两组治疗前、治疗6h和24h后冠脉血管直径、HR、SBP、DBP、血清心肌肌钙蛋白I (cTnI)、心脏型脂肪酸结合蛋白(H-FABP)和肌酸激酶同工酶(CK-MB)水平,及不良反应发生率。结果:与常规PCI组比较,右美托咪定组治疗6h、24h后冠脉血管直径[24h:(2.68±0.36)mm比(2.44±0.35)mm]、HR [24h:(86.56±8.12)次/min比(75.42±7.05)次/min]、DBP [24h:(76.26±10.30)mmHg比(68.28±9.25)mmHg]和SBP [24h:(133.17±23.76)mmHg比(118.28±10.26)mmHg]水平均显著降低,P均<0.01。与治疗前比较,治疗后6h、24h两组血清cTnI和CK-MB水平均依次显著升高,血清H-FABP水平均依次显著降低,P均=0.001。与常规PCI组比较,右美托咪定组治疗后6h、24h血清cTnI [24h:(1.23±0.05)ng/ml比(1.64±0.07)ng/ml]和CK-MB水平[24h:(125.09±13.16)μg/ml比(149.71±14.53)μg/ml]显著升高,血清H-FABP水平[24h:(10.44±2.59)ng/ml比(8.31±2.16)ng/ml]显著降低,P均=0.001。右美托咪定组不良反应发生率显著低于常规PCI组(6.52%比23.91%),P=0.020。结论:右美托咪定虽然对接受PCI治疗的AMI患者有收缩冠脉的作用,但可通过降低血压、心率等发挥心肌保护作用,且不良反应少,值得推广。Objective：To explore influence of dexmedetomidine（DEX）on coronary artery diameter and myocardial protection in patients with AMI undergoing PCI.Methods：A total of 92 AMI patients,who received PCI in our hospital from Mar 2016 to Mar 2017,were selected.Patients were randomly and equally divided into routine PCI group and DEX group（received DEX intravenous pump based on routine PCI group）.Coronary artery diameter,HR,SBP,DBP,serum levels of cardiac troponin I（cTnI）,heart type fatty acid-binding protein（H-FABP）and creatine kinase isoenzyme MB（CK-MB）before,6 hand 24 hafter treatment,and incidence of adverse reactions were observed and compared between two groups.Results：Compared with routine PCI group,on 6 hand 24 hafter treatment,there were significant reductions in coronary artery diameter[24 h：（2.68±0.36）mm vs.（2.44±0.35）mm],HR [24 h：（86.56±8.12）beats/min vs.（75.42±7.05）beats/min],DBP [24 h：（76.26±10.30）mmHgvs.（68.28±9.25）mmHg]and SBP [24 h：（133.17±23.76）mmHg vs.（118.28±10.26）mmHg]in DEX group,P〈0.01 all.Compared with before treatment group,there were significant rise respectively in serum levels of cTnI and CK-MB in two groups on 6 hand 24 hafter treatment,and serum H-FABP levels significantly decreased respectively,P=0.001 all.Compared with routine PCI group,on 6 hand 24 hafter treatment,there were significant rise in serum levels of cTnI [24 h：（1.23±0.05）ng/mlvs.（1.64±0.07）ng/ml]and CK-MB [24 h：（125.09±13.16）μg/ml vs.（149.71±14.53）μg/ml],and significant reduction in serum H-FABP level[24 h：（10.44±2.59）ng/ml vs.（8.31±2.16）ng/ml]in DEX group,P=0.001 all.Incidence rate of adverse reactions in DEX group was significantly lower than that of routine PCI group（6.52% vs.23.91%）,P=0.020.Conclusion：Though dexmedetomidine can constrict coronary artery,but it can perform myocardial protection through reducing blood pressure and HR etc.in AMI patients undergoing PCI,and its adverse reactions are few,which i

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 右美托咪定 

分 类 号：R542.22[医药卫生—心血管疾病]