右美托咪定对二尖瓣置换术患者左右心室收缩和舒张功能的影响  

Effects of dexmedetomidine on systolic and diastolic function of the left and right ventricles in patients undergoing mitral valve replacement

作　　者：王振红[1] 史宏伟[1] 刘寒玉 赵雅梅[1] 魏海燕[1] 葛亚力[1] WANG Zhenhong;SHI Hongwei;LIU Hanyu;ZHAO Yamei;WEI Haiyan;GE Yali(Department of Anesthesiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)麻醉科,210006

出　　处：《临床麻醉学杂志》2020年第9期847-851,共5页Journal of Clinical Anesthesiology

摘　　要：目的观察右美托咪定对心肺转流(CPB)下行二尖瓣置换术患者左右心室收缩和舒张功能的影响。方法择期CPB下行二尖瓣置换术患者32例,男9例,女23例,年龄42~70岁,BMI 18~28 kg/m 2,ASAⅡ或Ⅲ级。采用随机数字表法分为两组:右美托咪定组(D组)和对照组(C组)。两组术中麻醉维持均采用静脉复合麻醉,D组于切皮后经微量注射泵静脉注射右美托咪定负荷剂量1μg/kg,10 min内注射完后以0.5μg·kg-1·h-1维持给药至术毕,C组静脉注射等量生理盐水。于麻醉诱导后(T 0)、CPB停机后30 min(T 1)、60 min(T 2)记录HR、MAP、CVP、心脏指数(CI)、左心室射血分数(LVEF)等血流动力学指标,并于同时点记录二尖瓣瓣环等容收缩期峰值速度(Sm1)、射血期峰值速度(Sm2)、二尖瓣舒张早期血流峰值速度与二尖瓣瓣环舒张早期峰值速度的比值(E/Ea-MV)、三尖瓣瓣环等容收缩期峰值速度(St1)、射血期峰值速度(St2)、三尖瓣舒张早期峰值速度与三尖瓣瓣环舒张早期血流峰值速度的比值(E/Ea-TV)。结果与T 0时比较,T 1—T 2时两组HR明显增快(P<0.05),MAP明显降低(P<0.05),CVP、CI明显升高(P<0.05)。T 0—T 2时两组HR、MAP、CVP、CI、LVEF差异均无统计学意义。T 0—T 2时两组Sm1、Sm2、E/Ea-MV组内组间差异均无统计学意义。与T 0时比较,T 1—T 2时C组E/Ea-TV明显升高,T 2时D组E/Ea-TV明显升高(P<0.05)。T 0—T 2时两组St1、St2、E/Ea-TV差异无统计学意义。结论右美托咪定并不能改善左右心室舒张功能受损的程度,亦未增加心肌受损程度。Objective To evaluate effects of dexmedetomidine on systolic and diastolic function of the left and right ventricles in patients undergoing mitral valve replacement(MVR)under cardiopulmonary bypass(CPB).Methods Thirty-two patients,9 males and 23 females,aged 42-70 years,BMI 18-28 kg/m 2,ASA physical statusⅡorⅢ,undergoing MVR under CPB were randomized into dexmedetomidine group(group D)and control group(group C).Total intravenous anesthesia was used in both groups.In group D,1μg/kg bolus dose of dexmedetomidine was administered within 10 min after surgical incision,followed by a 0.5μg·kg-1·h-1 intravenous injection until the end of operation,while the same amount of normal saline was used instead of dexmedetomidine in group C.HR,MAP,CVP,cardiac index(CI),left ventricular ejection fraction(LVEF),left ventricle myocardial mechanics parameters such as Sm1,Sm2,E-MV,Ea-MV,and right ventricle myocardial mechanics parameters like St1,St2,E-TV,Ea-TV were recorded after anesthesia induction(T 0),at 30 min after CPB(T 1),and 60 min after CPB(T 2).Results Compared with T 0,HR,CVP and CI significantly increased at T 1-T 2 in both groups(P<0.05),while MAP significantly decreased(P<0.05).While comparison of HR,MAP,CVP,CI,and LVEF had no significance between the two groups.Sm1,Sm2,E/Ea-MV,St1,St2 and E/Ea-TV in group D compared with these in group C showed no statistical differences.Compared with T 0,E/Ea-TV significantly increased at T 1-T 2 in group C and at T 2 in group D(P<0.05).Conclusion Dexmedetomidine couldn t improve the impaired diastolic function of left and right ventricle.It didn’t increase the degree of myocardial injury.

关 键 词：右美托咪定 心室功能 左 心室功能 右 心脏瓣膜假体植入 超声心动图描记术 

分 类 号：R614[医药卫生—麻醉学]