右美托咪定在老年冠心病患者非心脏手术麻醉中的心肌保护作用  

Myocardial Protection of Dexmedetomidine during Anesthesia for Noncardiac Surgery in Elderly Patients with Coronary Heart Disease

作　　者：王娟[1] 王亚静 李茹 贾鹏 WANG Juan;WANG Ya-jing;LI Ru;JIA Peng(Department of Anesthesiology,Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou,Hebei 061001,China;Department of Anesthesiology,Cangxian Hospital,Cangxian,Hebei 061000,China)

机构地区：[1]河北省沧州中西医结合医院东院区麻醉科,河北沧州061000 [2]沧县医院麻醉科,河北沧县061000

出　　处：《临床误诊误治》2022年第6期69-73,83,共6页Clinical Misdiagnosis & Mistherapy

基　　金：沧州市科学计划自筹经费项目(183302008)。

摘　　要：目的探究右美托咪定在老年冠心病(CHD)患者非心脏手术麻醉中的心肌保护价值。方法选择2018年12月—2020年12月收治的择期行非心脏外科全麻手术的老年CHD患者134例。按照麻醉方法分为对照组和观察组,每组67例。2组均给予依托咪酯麻醉诱导及常规全身麻醉,观察组于麻醉诱导前泵注右美托咪定至手术结束,对照组予以0.9%氯化钠注射液静脉泵注。记录2组手术情况、心血管不良事件及肌阵挛发生情况;比较2组围术期不同时间点血流动力学及心肌损伤指标水平。结果2组手术时间、麻醉时间、出血量、输液量、住院时间比较差异无统计学意义(P>0.05)。在Ta1~Ta3时,2组收缩压(SBP)、舒张压(DBP)、心率均呈不断上升趋势,高于同组Ta0时,且观察组低于同时点对照组(P<0.05);在Ta4时,2组SBP、DBP、心率均较Ta3时降低,且观察组低于对照组(P<0.05)。在Tb1~Tb4时,2组心肌肌钙蛋白I(cTnI)、心型肌酸激酶同工酶(CK-MB)及N末端B型利钠肽前体(NT-proBNP)均高于Tb0时,于Tb3时达峰值后下降,且观察组低于对照组(P<0.05)。观察组心血管不良事件和肌阵挛发生率均低于对照组(P<0.05)。结论右美托咪定在老年CHD行非心脏手术患者麻醉中可进一步平衡机体血流动力学,保护心肌,降低患者心血管不良事件发生率,且可减少依托咪酯诱发的肌阵挛。Objective To investigate the myocardial protection of Dexmedetomidine in elderly patients with coronary heart disease(CHD)during anesthesia for non-cardiac surgery.Methods A total of 134 elderly CHD patients undergoing elective non cardiac surgery under general anesthesia from December 2018 to December 2020 were selected.They were divided into control group(n=67)and observation group(n=67)according to anesthesia method.Both groups were given etomidate for anesthesia induction and conventional general anesthesia.The observation group was given Dexmedetomidine by pump before anesthesia induction until the end of the operation,and the control group was given 0.9%sodium chloride injection by intravenous pump injection.The operation,adverse cardiovascular events and complications of the two groups were recorded.The levels of hemodynamics and myocardial injury indexes at different time points during the perioperative period were compared between the two groups.Results There were no significant differences in duration of operation,duration of anesthesia,blood loss,infusion volume and length of hospital stay between the two groups(P>0.05).At Ta1~Ta3,systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)in both groups showed an increasing trend,which were higher than those at Ta0,and lower in the observation group than in the control group at the same time point(P<0.05).At Ta4,SBP,DBP and HR in both groups were lower than those at Ta3,which were lower in the observation group than in the control group(P<0.05).At Tb1~Tb4,cardiac troponin I(cTnI),cardiac type creatine kinase isoenzyme(CK-MB)and N-terminal B-type natriuretic peptide precursor(NT-proBNP)in both groups were higher than those at Tb0,and then decreased after reaching the peak at Tb3,which were lower in the observation group than in the control group(P<0.05).The incidence of cardiovascular adverse events and myoclonus in the observation group was lower than that in the control group(P<0.05).Conclusion Dexmedetomidine can further balance hemo

关 键 词：冠心病 非心脏手术 右美托咪定 依托咪酯 血流动力学 肌钙蛋白I 肌酸激酶同工酶 N末端B型利钠肽前体 

分 类 号：R541.4[医药卫生—心血管疾病] R614[医药卫生—内科学]