麻醉诱导前不同剂量右美托咪定在老年冠心病非心脏手术患者中的应用效果  

Application Effects of Different Doses of Dexmedetomidine Before Anesthesia Induction in Elderly Patients with Coronary Heart Disease Undergoing Non-cardiac Surgery

作　　者：刘晶涛[1] 杨艳[1] LIU Jingtao;YANG Yan(Department of Anesthesia,Anyang District Hospital,Anyang 455000,China)

机构地区：[1]濮阳市安阳地区医院麻醉科,河南安阳455000

出　　处：《河南医学研究》2024年第23期4319-4323,共5页Henan Medical Research

摘　　要：目的探究麻醉诱导前不同剂量右美托咪定在老年冠心病非心脏手术患者中的应用效果。方法选取濮阳市安阳地区医院2018年1月至2022年10月收治的200例老年冠心病非心脏手术患者为研究对象,将其依据随机数字表法分为对照组、D1组、D2组、D3组,4组均为50例,D1组、D2组、D3组分别在麻醉诱导前10 min泵注0.50、0.75、1.00μg·kg^(-1)右美托咪定,对照组泵注等剂量生理盐水,比较4组患者术中情况以及麻醉诱导前(T_(0))、术毕(T_(1))、术后24 h(T_(2))、术后48 h(T_(3))心肌损伤、氧化应激相关指标,统计不良事件发生情况。结果4组患者手术时间、苏醒时间差异无统计学意义(P>0.05)。D1组、D2组、D3组舒芬太尼用量低于对照组,D1组低于D2组、D3组(P<0.05);D2组、D3组舒芬太尼用量差异无统计学意义(P>0.05)。T_(0)时刻,4组血清肌钙蛋白I(cTnI)、氨基末端B型利尿钠肽前体(NT-proBNP)水平差异无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)时刻上述血清指标均高于T_(0)时刻(P<0.05);T_(1)、T_(2)、T_(3)时刻,D1组、D2组、D3组上述血清指标均低于对照组,且D1组上述血清指标均低于D2组、D3组(P<0.05);D2组、D3组各时间点上述血清指标差异无统计学意义(P>0.05)。T_(0)时刻,4组患者血清丙二醛(MDA)、超氧化物歧化酶(SOD)水平差异无统计学意义(P>0.05),T_(1)、T_(2)、T_(3)时刻MDA水平均高于T_(0)时刻,SOD水平均低于T_(0)时刻(P<0.05);T_(1)、T_(2)、T_(3)时刻,D1组、D2组、D3组MDA水平均低于对照组,SOD水平高于对照组,且D1组上述血清指标均优于D2组、D3组(P<0.05);D2组、D3组各时间点上述血清指标差异无统计学意义(P>0.05)。结论老年冠心病非心脏手术患者麻醉诱导前应用小剂量右美托咪定,可保护心肌,减少氧化应激反应,且安全性良好。Objective To investigate the application effects of different doses of dexmedetomidine before anesthesia induction in elderly patients with coronary heart disease undergoing non-cardiac surgery.Methods A total of 200 elderly patients with coronary heart disease who underwent non-cardiac surgery in Anyang District Hospital from January 2018 to October 2022 were selected as the study subjects.They were divided into control group,D1 group,D2 group and D3 group by random number table method,with 50 patients in each group.D1 group,D2 group and D3 group were injected with 0.50,0.75 and 1.00μg·kg^(-1)of dexmedetomidine at 10 min before anesthesia induction,respectively.The control group was injected with equal dose of normal saline.The four groups were compared in terms of intraoperative conditions and indicators related to myocardial injury and oxidative stress before anesthesia induction(T_(0)),at the end of surgery(T_(1)),24 h after surgery(T_(2))and 48 h after surgery(T_(3)).The incidence of adverse events was statistically analyzed.Results There was no statistically difference in surgical time and recovery time among the four groups of patients(P>0.05).The dosage of sufentanil in groups D1,D2,and D3 was lower than that in the control group,and the dosage in group D1 was lower than that in groups D2 and D3(P<0.05).There was no statistically difference in the dosage of sufentanil between group D2 and group D3(P>0.05).At T_(0),there was no statistically difference in the levels of serum troponin I(cTnI)and N-terminal pro-B-type natriuretic(NT-proBNP)among the four groups(P>0.05).At T_(1),T_(2),and T_(3),the above serum indicators were all higher than at time T_(0)(P<0.05).At T_(1),T_(2),and T_(3),the serum indicators of D1 group,D2 group,and D3 group were all lower than those of the control group,and the serum indicators of D1 group were all lower than those of D2 group and D3 group(P<0.05).There was no statistically difference in the above serum indicators between the D2 and D3 groups at each time point(P>0.05).At

关 键 词：冠心病 非心脏手术 右美托咪定 老年人 小剂量 心肌保护 氧化应激 

分 类 号：R614[医药卫生—麻醉学]