盐酸右美托咪定联合酒石酸布托啡诺对行瓣膜置换术患者术后炎性反应及心肌损伤的影响  

Influence of dexmedetomidine hydrochloride combined with butorphanol tartrate on inflammatory response and myocardial injury after valve replacement

作　　者：邵海涛 吴亚辉 王韬甫 徐红党 林洪启 SHAO Hai-tao;WU Ya-hui;WANG Tao-fu;XU Hong-dang;LIN Hong-qi(Department of Anesthesiology,Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People's Hospital,Zhengzhou University Fuwai Central China Cardiovascular Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]阜外华中心血管病医院、河南省人民医院心脏中心、郑州大学阜外华中心血管病医院麻醉科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2023年第5期522-527,共6页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 观察盐酸右美托咪定联合酒石酸布托啡诺对行瓣膜置换术后患者炎性反应、心肌损伤的影响,探讨其镇痛效果及安全性。方法 行瓣膜置换术患者80例,随机分为观察组和对照组各40例。对照组在麻醉诱导前静脉注射酒石酸布托啡诺注射液0.02 mg/kg,观察组在对照组基础上静脉注射盐酸右美托咪定注射液0.5μg/kg;2组麻醉诱导均静脉注射依托咪酯0.2 mg/kg+苯磺顺阿曲库铵0.2 mg/kg+枸橼酸舒芬太尼0.4μg/kg;术中采用体积分数1%~3%七氟烷吸入维持麻醉,酌情追加苯磺顺阿曲库铵、枸橼酸舒芬太尼,维持脑电双频指数在45~55。对照组术后应用盐酸阿扎司琼+酒石酸布托啡诺+质量分数0.9%氯化钠溶液静脉自控镇痛,观察组在对照组基础上静脉注射盐酸右美托咪定0.5μg/kg。采集2组术前及术后48 h空腹静脉血,采用ELISA法检测血清高敏C反应蛋白(high-sensitivity C-reactive protein, hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)、白细胞介素-6(interleukin-6,IL-6)、磷酸肌酸激酶(creatine kinase,CK)、CK-MB、心肌肌钙蛋白I(cardiac troponin I, cTnI)水平。采用疼痛视觉模拟评分(visual analogue scale,VAS)及Ramsay镇静评分评估2组术后即刻(T_(0))、术后24 h(T_(1))、术后48 h(T_(2))疼痛及镇静情况。记录2组ICU治疗时间、苏醒时间、拔管时间及住院期间呕吐、嗜睡等不良反应发生情况。结果 (1)2组年龄、性别比例、体质量指数、NYHA心功能分级、ASA分级、手术时间及风湿性心脏病、感染性心内膜炎、瓣膜退行性病变、先天性瓣膜畸形、糖尿病、冠心病、高血压比率比较差异均无统计学意义(P>0.05)。(2)观察组ICU治疗时间[(20.14±2.15)h]、苏醒时间[(7.11±0.73)h]、拔管时间[(12.74±1.31)h]均短于对照组[(25.34±2.56)h、(7.68±0.78)h、(15.32±1.56)h](P<0.05)。(3)术前2组TNF-α、IL-6、hs-CRP、CK、CK-MB、cTnI水平比较差异均无统计学意义(P>0.05Objective To observe the influence of dexmedetomidine hydrochloride combined with butorphanol tartrate on inflammatory response and myocardial injury after valve replacement,and to investigate the analgesic effect and safety.Methods Eighty patients undergoing valve replacement were equally and randomly divided into observation group and control group.Control group was intravenously injected with butorfenol tartrate 0.02mg/kg before anesthesia induction,besides which observation group was intravenously injected with dexmedetomidine 0.5μg/kg.Both groups were given intravenous etonidate etopidate emulsion 0.2mg/kg+cis-atracurium besylate 0.2mg/kg+sufentanil citrate 0.4μg/kg for anesthesia induction.During operation,the sevoflurane 1%to 3%was inhaled to maintain anesthesia,and cis-atracurium besylate and sufentanil citrate were added if necessary to keep the bispect ral index at 45to 55.For intravenous self-controlled analgesia after surgery,control group received azasetron hydrochloride+butorphanol tartrate+sodium chloride 0.9%,and observation group was given intravenous dexmedetomidine hydrochloride0.5μg/kg besides the method of control group.The serum high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),creatine kinase(CK),CK-MB and cardiac troponin I(CTnI)levels in the fasting venous blood were detected before and 48hafter surgery in two groups.The visual analogue scale(VAS)and Ramsay sedation score were used to evaluate pain and sedation efficacies at the time points of immediately after surgery(T_(0)),24h postoperatively(T_(1)),and 48hpostoperatively(T_(2))in two groups.The length of ICU stay,awakening time,extubation time,and adverse reactions as vomiting and drowsiness during hospitalization were recorded in two groups.Results(1)There were no significant differences in the age,gender ratio,body mass index,NYHA grade,ASA grade,operation lasting time,and incidences of rheumatic heart disease,infective endocarditis,valvular degeneration,congenital valve malformation

关 键 词：瓣膜置换术 盐酸右美托咪定 酒石酸布托啡诺 炎性反应 心肌损伤 

分 类 号：R614[医药卫生—麻醉学]