右美托咪定联合芬太尼对心脏瓣膜置换术后患者心肌和肾功能的影响  

Effects of dexmedetomidine combined with fentanyl on myocardial injury and renal function after heart valve replacement

作　　者：梁东锋[1] 王秋锋 邓海波 梁启胜[2] 刘磊[3] Dong-feng Liang;Qiu-fengWang;Hai-bo Deng;Qi-sheng Liang;Lei Liu(Department of Anesthesiology,Fuyang People's Hospital,Fuyang,Anhui 236000,China;Department of Anesthesiology,The First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China;Department of Cardiovascular Surgery,Fuyang People's Hospital,Fuyang,Anhui 236000,China)

机构地区：[1]阜阳市人民医院麻醉科,安徽阜阳236000 [2]蚌埠医学院第一附院麻醉科,安徽蚌埠233004 [3]阜阳市人民医院心脏大血管外科,安徽阜阳236000

出　　处：《中国现代医学杂志》2021年第17期24-28,共5页China Journal of Modern Medicine

基　　金：阜阳市自筹经费科技计划项目(No:FK202081020)。

摘　　要：目的探讨右美托咪定联合芬太尼对心脏瓣膜置换术后心肌和肾功能的影响。方法选取2017年1月—2020年12月阜阳市人民医院择期行体外循环(CPB)下心脏瓣膜置换术的患者作为研究对象,共86例。按照随机数字表法分为观察组和对照组,每组43例。两组患者均以芬太尼进行麻醉诱导及麻醉维持。观察组在麻醉诱导前10 min予以静脉泵注右美托咪定0.4μg/(kg·h)维持至手术结束。采集两组患者外周静脉血标本,检测并比较两组患者用药前(T_(0))、术中(T_(1))、术后24 h(T_(2))的平均动脉压(MAP)、氧饱和度(SpO_(2))、心率(HR)、肌酸激酶同工酶(CK-MB)、血清胱抑素C(CysC)及尿素氮(BUN)水平。采用视觉模拟评分(VAS)判定两组患者不同时间点的疼痛程度。比较两组患者术后14 d内不良反应发生率。结果两组患者不同时间点MAP、SpO_(2)、HR和VAS评分比较:①不同时间点的MAP、SpO_(2)、HR和VAS评分有差异(P<0.05);②两组患者MAP、SpO_(2)、HR和VAS评分有差异(P<0.05);③两组患者MAP、SpO_(2)、HR和VAS评分随时间变化趋势有差异(P<0.05);两组患者不同时间点CK-MB、CysC和BUN水平比较:①不同时间点的CK-MB、CysC和BUN有差异(P<0.05);②两组患者CK-MB、CysC和BUN无差异(P>0.05);③两组患者CK-MB、CysC和BUN随时间变化趋势有差异(P<0.05)。两组呼吸抑制、剧烈疼痛及不良反应总发生率比较,差异有统计学意义(P<0.05),观察组低于对照组。两组恶心呕吐、低血压发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定联合芬太尼对心脏瓣膜置换术患者镇痛效果显著,不良反应发生率低,且不会对血流动力学、心、肾功能产生额外负担,值得临床推广。Objective To investigate the effects of dexmedetomidine combined with fentanyl on myocardial injury and renal function after heart valve replacement.Methods From January 2017 to December 2020,86 patients with heart valve replacement under CPB in our hospital were selected as the research subjects.By random number table method,they were divided into experimental group and control group,with 43 patients in each group.Fentanyl was used for anesthesia induction and maintenance in both groups.The observation group was given dexmedetomidine 0.4μg/(kg·h)by intravenous pump 10 min before anesthesia induction until the end of operation.Peripheral venous blood samples were collected from patients in the two groups to detect and compare levels of MAP,SpO_(2),HR,CK-MB,Cystatin C(CysC),and BUN before treatment(T_(0)),during surgery(T_(1)),and 24 h after surgery(T_(2)).Visual analogue pain scale(VAS)was used to evaluate the pain degree in two groups at different time points.The incidence of adverse reactions within 14 days after operation was compared.Results The scores of MAP,SpO_(2),HR,and VAS at different time points were different(P<0.05).Among them,the scores of map,SpO_(2),HR,and VAS were different at different time points(P<0.05);there were differences in MAP,SpO_(2),HR,and VAS scores between the two groups(P<0.05);there were differences in the trend of MAP,SpO_(2),HR,and VAS scores between the two groups with time(P<0.05);Comparison of CK-MB,CysC and BUN levels between the two groups at different time points:there were differences in CK-MB,CysC,and BUN at different time points(P<0.05);there was no difference in CK-MB,CysC,and BUN between the two groups(P>0.05);there was significant difference in the change trend of CK-MB,CysC,and BUN with time between the two groups(P<0.05).There was significant difference in the total incidence of respiratory depression,severe pain,and adverse reactions between the two groups(P<0.05),which was lower in the observation group than in the control group.There was no significant differen

关 键 词：心脏瓣膜疾病 心脏瓣膜置换术 右美托咪定 芬太尼 

分 类 号：R614[医药卫生—麻醉学]