右美托咪定对心脏瓣膜置换术后心肌的保护作用  

Protective effect of Dex on myocardium after heart valve replacement

作　　者：张朝贵[1] 何治江 阳倩虹 曹良海[1] 黄涛[1] 邱俊[1] Zhang Chaogui;He Zhijiang;Yang Qianhong;Cao Lianghai;Huang Tao;Qiu Jun(ICU,the Second People's Hospital of Yibin Yibin Hospital of West China Hospital of Sichuan University,Yibin,Sichuan,644000,China)

机构地区：[1]宜宾市第二人民医院·四川大学华西医院宜宾医院重症医学科,四川宜宾644000

出　　处：《西南国防医药》2021年第5期386-390,共5页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的探究术后右美托咪定(Dex)对体外循环条件下心脏瓣膜置换手术中心肌的恢复作用。方法本研究共纳入179例行体外循环条件下瓣膜置换手术的患者,并分为Dex组(87例)和对照组(92例)。在手术前、用药前和用药后24 h对患者的相关指标进行监测,测定的参数包括患者的心率(HR)和平均动脉压(MAP)、血清心肌肌钙蛋白T(cTnT)和白细胞介素(IL-8)。比较两组患者上述指标的差异。此外,记录患者术后ICU期间出现的并发症情况,并分析其影响因素。结果两组患者的基线临床信息无显著差异(P>0.05)。在手术后,Dex的使用可以显著降低心率、提高MAP(P<0.05)。手术后两组患者cTnT和IL-8都显著升高,但术后使用Dex患者的cTnT和IL-8水平显著低于对照组患者(P<0.05)。Dex组术后机械通气时间显著低于对照组(P<0.05),谵妄的发生率要显著低于对照组(P<0.05)。主动脉阻断时间>70 min、体外循环时间>110 min和未使用Dex(OR=1.34,1.17~2.08,P<0.05)是患者出现并发症的独立危险因素。结论在体外循环心脏瓣膜置换术中,术后使用Dex能显著减轻心肌损伤,降低并发症。Dex是体外循环手术的有效的保护剂。Objective To explore the protective effect of dexmedetomidine(Dex)on recovery of myocardium after heart valve replacement under cardiopulmonary bypass.Methods A total of 179 patients undergoing valve replacement under cardiopulmonary bypass were enrolled in this study and divided into a Dex group(n=87)and a control group(n=92).Indicators of patients were monitored before operation,before medication,and 24 h after medication.The parameters measured included heart rate(HR),mean arterial pressure(MAP),serum cardiac troponin T(cTnT)and interleukin(IL-8).The differences in these parameters between the two groups were compared.In addition,postoperative complications of patients in ICU were recorded and their influencing factors were analyzed.Results There was no significant difference in baseline clinical information between the two groups.The postoperative use of Dex significantly reduced heart rate and increased MAP(P<0.05).After operation,the levels of cTnT and IL-8 in the two groups significantly increased,but the levels of cTnT and IL-8 in the Dex group were significantly lower than those in the control group(P<0.05).The duration of postoperative mechanical ventilation in the Dex group was significantly lower than that in the control group(P<0.05),and the incidence of delirium in the Dex group(5.7%)was significantly lower than that in the control group(15.2%,P<0.05).Aortic crossclamp time>70 min(OR=2.89,2.08-3.97,P<0.001),cardiopulmonary bypass time>110 min(OR=2.41,1.37-3.39,P<0.05)and use of Dex(OR=1.34,1.17-2.08,P<0.05)were independent risk factors for complications.Conclusion In heart valve replacement,postoperative use of Dex significantly reduces myocardial injury and complications.Dex is an effective protective agent for cardiopulmonary bypass.

关 键 词：右美托咪定 心脏保护 心脏瓣膜手术 体外循环 心肌缺血/再灌注损伤 

分 类 号：R654.2[医药卫生—外科学]