右美托咪定复合七氟醚对冠心病患者非心脏手术后心肌损伤及氧化应激反应的影响  

Effect of dexmedetomidine combined with sevoflurane on myocardial injury and oxidative stress response after non-cardiac surgery in patients with coronary heart disease

作　　者：曾凯辉[1] ZENG Kai hui(Department of Anaesthesiology, the First Affiliated Hospital of Guangzhou Medical University in Guangdong Province, Guangzhou City, Guangdong Province, 510120, China)

机构地区：[1]广东省广州医科大学附属第一医院麻醉科,广东广州510120

出　　处：《海南医学院学报》2017年第18期2468-2471,2475,共5页Journal of Hainan Medical University

基　　金：广东省科技计划项目(2014A020212351)~~

摘　　要：目的:研究右美托咪定复合七氟醚对冠心病患者非心脏手术后心肌损伤及氧化应激反应的影响。方法:选择在本院接受腹部手术且合并冠心病的104例患者并随机分为对照组(C组)、右美托咪定组(D组)、七氟醚组(S组)、右美托咪定+七氟醚组(D+S组),观察麻醉情况并检测手术前、手术后24小时血清中心肌损伤标志物、血管活性分子、氧化应激指标的含量。结果:四组患者的拔管时间、PACU停留时间、ICU停留时间以及术后心律失常发生率、血压异常的发生率均无显著性差异;手术后24小时,四组患者血清中H-FABP、cTnI、CK-MB、Myo、NT-proBNP、NT-proANP、AT-II、ALD、IMA、MDA的含量及外周血中Nrf-2、ARE的表达量均显著高于手术前且D组、S组、D+S组血清中HFABP、cTnI、CK-MB、Myo、NT-proBNP、NT-proANP、AT-II、ALD、IMA、MDA的含量及外周血中Nrf-2、ARE的表达量均显著低于C组,D+S组血清中H-FABP、cTnI、CK-MB、Myo、NT-proBNP、NT-proANP、AT-II、ALD、IMA、MDA的含量及外周血中Nrf-2、ARE的表达量均显著低于D组、S组。结论:右美托咪定复合七氟醚能够减轻冠心病患者非心脏手术后的心肌损伤及氧化应激反应。Objective:To study the effect of dexmedetomidine combined with sevoflurane on myocardial injury and oxidative stress response after non cardiac surgery in patients with coronary heart disease.Methods:104patients with coronary heart disease who received abdominal operation in the First Affiliated Hospital of Guangzhou Medical University between March2015and February2017were selected and randomly divided into control group(group C),dexmedetomidine group(group D),sevoflurane group(group S)and dexmedetomidine+sevoflurane group(group D+S),the anesthesia was observed,and serum levels of myocardial injury markers,vasoactive molecules and oxidative stress indexes were detected before operation and24hours after operation.Results:The extubation time,PACU staying time and ICU staying time as well as the incidence of postoperative arrhythmias and dysarteriotony were not significantly different among the four groups;24hours after the surgery,H FABP,cTnI,CK MB,Myo,NT proBNP,NT proANP,AT II,ALD,IMA and MDA contents in serum as well as Nrf2and ARE expression in peripheral blood of four groups of patients were significantly higher than those before operation,H FABP,cTnI,CK MB,Myo,NT proBNP,NT proANP,AT II,ALD,IMA and MDA contents in serum as well as Nrf2and ARE expression in peripheral blood of group D,group S and group D+S were significantly lower than those of group C,and H FABP,cTnI,CK MB,Myo,NT proBNP,NT proANP,AT II,ALD,IMA and MDA contents in serum as well as Nrf2and ARE expression in peripheral blood of group D+S were significantly lower than those of group D and group S.Conclusion:Dexmedetomidine combined with sevoflurane can reduce the myocardial injury and oxidative stress response after non cardiac surgery in patients with coronary heart disease.

关 键 词：右美托咪定 七氟醚 心肌损伤 氧化应激 

分 类 号：R541.4[医药卫生—心血管疾病]