不同剂量右美托咪定在心脏瓣膜置换术中的应用效果及不良反应的比较  

Effects and adverse reactions of different doses of dexmedetomidine on heart valve replacement surgery

作　　者：吴玉亭 付山[1] Wu Yuting;Fu Shan(Department of Anesthesiology,Hanzhong Central Hospital,Hanzhong 723000,Shaanxi Province,China)

机构地区：[1]汉中市中心医院麻醉科,汉中723000

出　　处：《中国基层医药》2025年第2期222-227,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的比较不同剂量右美托咪定在进行体外循环(cardiopulmonary bypass, CPB)心脏瓣膜置换术中的应用效果及不良反应。方法选取2021年1月至2023年12月在汉中市中心医院择期接受CPB心脏瓣膜手术的患者110例进行前瞻性研究, 采用随机对照研究方法, 采用随机数字表法将患者分为对照组(n=55)和观察组(n=55);对照组在麻醉诱导后静脉给予0.4 μg·kg^(-1)·h^(-1)的右美托咪定, 观察组则给予0.2 μg·kg^(-1)·h^(-1);观察比较两组手术参数(CPB持续时间、主动脉阻断时间、手术持续时间、出血量和心脏自主搏动恢复率)、手术前后的相关心肌标志物水平[脑利钠肽(BNP)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、可溶性生长刺激表达基因2蛋白(sST2)、心型脂肪酸结合蛋白(hFABP)]及手术期间和术后6 h的不良反应发生率。结果两组患者的CPB时长、主动脉阻断时长、手术时间长度、手术出血量、心脏自动复跳率等差异均无统计学意义(t=0.38、0.90、-0.48、-0.67, χ^(2)=0.04, 均P > 0.05);与手术前相比, 术后24 h, 两组患者的BNP、CK-MB、cTnT、sST2、hFABP等均有显著升高, 差异均有统计学意义(t=-11.72、-12.77、8.80、8.92、-15.73、-12.34、-31.03、-37.27、-8.64、-7.92, 均P < 0.05), 但两组间比较, 差异均无统计学意义(均P > 0.05);观察组的术中和术后6 h的不良反应发生率低于对照组[1.82%(1/55)比14.55%(8/55)、5.45%(3/55)比18.18%(10/55)], 差异均有统计学意义(χ^(2)=4.36、4.27, 均P < 0.05)。结论 0.2 μg·kg^(-1)·h^(-1)与0.4 μg·kg^(-1)·h^(-1)的右美托咪定都可用于心脏瓣膜置换手术, 前者不良反应发生率更低。Objective:To compare the effects and adverse reactions of different doses of dexmedetomidine in patients undergoing cardiopulmonary bypass(CPB)for heart valve replacement surgery.Methods:A prospective study was conducted on 110 patients who underwent elective heart valve replacement surgery under cardiopulmonary bypass at Hanzhong Central Hospital from January 2021 to December 2023.This study used a randomized controlled trial design.The patients were randomly assigned to a control group(n=55)and an observation group(n=55)using a random number table.The control group received intravenous dexmedetomidine at a dose of 0.4μg·kg^(-1)·h^(-1) after anesthesia induction,while the observation group received intravenous dexmedetomidine at a dose of 0.2μg·kg^(-1)·h^(-1).Various surgical parameters(CPB duration,aortic cross-clamp time,total operative time,blood loss,and the rate of spontaneous cardiac rhythm recovery),pre-and post-operative levels of key cardiac biomarkers(B-type natriuretic peptide,creatine kinase-MB,cardiac troponin T,soluble ST2,and heart-type fatty acid binding protein),and the incidence of adverse reactions that occurred during surgery and within 6 hours after surgery were compared between the two groups.Results:There were no statistically significant differences between the two groups regarding CPB duration,aortic cross-clamp time,total operative time,blood loss,or rate of spontaneous cardiac rhythm recovery(t=0.38,0.90,-0.48,-0.67,χ^(2)=0.04,all P>0.05).The levels of B-type natriuretic peptide,creatine kinase-MB,cardiac troponin T,soluble ST2,and heart-type fatty acid binding protein measured within 24 hours after surgery were significantly higher than those measured before surgery(t=-11.72,-12.77,8.80,8.92,-15.73,-12.34,-31.03,-37.27,-8.64,-7.92,all P<0.05).However,no significant differences in these indices were observed between the two groups(all P>0.05).The incidence of adverse reactions that occurred during surgery and within 6 hours after surgery was significantly lower in the observatio

关 键 词：心脏瓣膜假体置入 体外循环 麻醉前用药 心肌再灌注损伤 手术中并发症 手术后并发症 右美托咪定 

分 类 号：R614[医药卫生—麻醉学]