盐酸右美托咪定对急性心肌梗死患者行PCI治疗的心肌保护作用
发布时间：2018-08-11 18:42
【摘要】：目的 观察盐酸右美托咪定(Dex)对AMI患者PCI术中的镇静、镇痛、抗焦虑、减轻应激反应、减轻炎症反应的作用，评价Dex对心肌细胞的保护作用及其对预后的影响；观察Dex对肝肾功能的影响，评价应用Dex的安全性及有效性，为临床挽救更多心肌提供一种安全、有效的方法。 方法 收集2012年08月至2013年03月就诊于我院心血管内科初发AMI发病12h内入院的患者60例，将符合入选标准的患者随机分为2组：对照组(C组)30例接受常规PCI治疗，盐酸右美托咪定组(D组)30例在常规PCI治疗过程中给予静脉微泵注射Dex，术中根据镇静评分(RASS评分)和疼痛评分(VAS评分)增加或减少药物剂量，术后停止注射。记录所有患者在给药前(T0)及给药后10min(T1)、30min(T2)、1h(T3)、2h(T4)、4h(T5)、12h(T6)的收缩压(SBP)、舒张压(DBP)和心率(HR)变化。分别于术前及术后8h、16h、24h、48h、72h测定血清心肌肌钙蛋白(IcTnI)和血清肌酸激酶同工酶(CK-MB)浓度。分别于术前和术后24h测定超敏C反应蛋白(hsCRP)浓度和中性粒细胞计数(ANC)。所有患者术前和术后1月分别行心脏超声检查，测定左心室射血分数(LVEF)及室壁运动记分指数(WMSI)的变化。于术前和术后24h测定血清肌酐(Scr)、血尿素氮(BUN)、胱抑素C(CysC)、谷丙转氨酶(ALT)、谷草转氨酶(AST)浓度，并记录两组患者术后24h内总尿量。 结果 1两组患者的性别、年龄、危险因素、术前时间、冠脉病变程度、支架植入情况和术后用药情况等无统计学差异(P0.05)。 2两组患者在T0时点SBP、DBP和HR相比无显著性差异(P0.05)。与T0相比，D组在T1、T2、T3、T4、T5、T6时点SBP、DBP、HR显著降低(P0.05)；C组T1、T2、T3、T4、T5、T6时点SBP、DBP、HR与T0比较显著升高(P0.05)。在T1、T2、T3、T4、T5、T6各时点D组的SBP、DBP、HR显著低于C组(P0.05)。 3C组和D组PCI术前cTnI、CK-MB比较，差异无统计学意义(P0.05)；术后D组患者cTnI、CK-MB峰浓度明显低于C组，差异有统计学意义(P0.05)。 4术前hsCRP浓度、ANC两组比较均无明显统计学差异(P0.05)；但术后24h，D组的hsCRP浓度、ANC明显低于C组，差异有统计学意义(P0.05)。 5术前两组患者LVEF值和WMSI值比较无明显统计学差异(P0.05)；但术后1月，D组的LVEF值明显高于C组(P0.05)，，WMSI值明显低于C组，差异有统计学意义(P0.05)。 6C组患者术前和术后24hScr、BUN、CysC比较，差异无统计学意义(P0.05)；D组患者术后24hScr、BUN、CysC较术前明显降低，差异有统计学意义(P0.05)。C组和D组患者术前Scr、BUN、CysC、ALT、AST比较，差异无统计学意义(P0.05)；术后24hD组患者Scr、BUN、CysC较C组明显降低，差异有统计学意义(P0.05)。术后24h两组间ALT、AST比较，未见明显差异(P0.05)。D组患者术后24h内总尿量较C组明显增多，差异有统计学意义(P0.05)。 结论 1PCI术中静脉应用Dex，对AMI患者产生镇静、镇痛、抗焦虑作用，减轻应激反应。 2PCI术中对AMI患者静脉应用Dex，可减轻患者的炎症反应。 3PCI术中对AMI患者静注Dex，可减轻心肌的进一步损伤，产生心肌保护作用，且改善预后。 4Dex具有肾脏保护作用，且对肝功能无损害，应用安全有效。
[Abstract]:objective
To observe the effects of dexmedetomidine hydrochloride (Dex) on sedation, analgesia, anti-anxiety, stress relief and inflammatory reaction in patients with AMI undergoing PCI, to evaluate the protective effect of Dex on myocardial cells and its prognosis, to observe the effect of Dex on liver and kidney function, to evaluate the safety and effectiveness of Dex in order to save more myocardium for clinical use. For a safe and effective way.
Method
Sixty patients hospitalized within 12 hours of the onset of AMI in our hospital from August 2012 to March 2013 were randomly divided into two groups: 30 patients in control group (group C) received conventional PCI treatment, 30 patients in dexmedetomidine hydrochloride group (group D) received intravenous micropump Dex during conventional PCI treatment. Sedation score (RASS score) and pain score (VAS score) increased or decreased the dosage of the drug and stopped the injection after the operation. Serum SBP, DBP and HR were measured at 8, 16, 24, 48 and 72 hours before and after the administration (T0) and 10 minutes (T1), 30 minutes (T2), 1 hour (T3), 2 hours (T4), 4 hours (T5), 12 hours (T6). The levels of cardiac troponin (IcTnI) and serum creatine kinase isoenzyme (CK-MB) were measured before operation and 24 hours after operation respectively. The levels of hypersensitive C-reactive protein (hsCRP) and neutrophil count (ANC) were measured before and 1 month after operation. Serum creatinine (Scr), blood urea nitrogen (BUN), cystatin C (CysC), alanine aminotransferase (ALT) and glutamic oxaloacetic transaminase (AST) were measured before and 24 hours after operation. The total urine volume of the two groups was recorded within 24 hours after operation.
Result
There were no significant differences in gender, age, risk factors, preoperative time, degree of coronary artery lesion, stent implantation and postoperative medication between the two groups (P 0.05).
Compared with T0, SBP, DBP and HR in group D at T1, T2, T3, T4, T5, T6 decreased significantly (P 0.05); SBP, DBP, HR in group C at T1, T2, T3, T4, T5, T6 increased significantly (P 0.05). SBP, DBP, HR in group D at T1, T2, T4, T5, T6 were significantly lower than those in group C (P 0.05).
There was no significant difference in cTnI and CK-MB between group 3C and group D before PCI (P 0.05); the peak concentrations of cTnI and CK-MB in group D after PCI were significantly lower than those in group C (P 0.05).
There was no significant difference in the concentration of hsCRP between ANC group and preoperative group (P 0.05), but the concentration of hsCRP in group D was significantly lower than that in group C 24 hours after operation (P 0.05).
There was no significant difference in LVEF and WMSI between the two groups before operation (P 0.05), but the LVEF in group D was significantly higher than that in group C (P 0.05) and the WMSI was significantly lower than that in group C (P 0.05).
Scr, BUN, CysC were significantly lower in group D than in group C (P 0.05). Scr, BUN, CysC were significantly lower in group C and group D (P 0.05). Scr, BUN, CysC, ALT and AST were significantly lower in group D than in group C (P 0.05). Scr, BUN, CysC were significantly lower in group D than in group C at 24 hours after operation (P 0.05). There was no significant difference in ALT and AST between the two groups 24 hours after operation (P 0.05). The total urine volume in group D was significantly higher than that in group C within 24 hours after operation (P 0.05).
conclusion
Intravenous Dex during PCI can produce sedation, analgesia, anti-anxiety and alleviate stress reaction in patients with AMI.
2PCI in patients with AMI Dex intravenous application, can reduce the inflammatory response of patients.
Intravenous injection of Dex in patients with AMI during 3PCI can alleviate further myocardial injury, produce myocardial protection and improve prognosis.
4Dex has a protective effect on the kidney, and has no damage to liver function, and is safe and effective.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22
本文编号：2177881
[Abstract]:objective
To observe the effects of dexmedetomidine hydrochloride (Dex) on sedation, analgesia, anti-anxiety, stress relief and inflammatory reaction in patients with AMI undergoing PCI, to evaluate the protective effect of Dex on myocardial cells and its prognosis, to observe the effect of Dex on liver and kidney function, to evaluate the safety and effectiveness of Dex in order to save more myocardium for clinical use. For a safe and effective way.
Method
Sixty patients hospitalized within 12 hours of the onset of AMI in our hospital from August 2012 to March 2013 were randomly divided into two groups: 30 patients in control group (group C) received conventional PCI treatment, 30 patients in dexmedetomidine hydrochloride group (group D) received intravenous micropump Dex during conventional PCI treatment. Sedation score (RASS score) and pain score (VAS score) increased or decreased the dosage of the drug and stopped the injection after the operation. Serum SBP, DBP and HR were measured at 8, 16, 24, 48 and 72 hours before and after the administration (T0) and 10 minutes (T1), 30 minutes (T2), 1 hour (T3), 2 hours (T4), 4 hours (T5), 12 hours (T6). The levels of cardiac troponin (IcTnI) and serum creatine kinase isoenzyme (CK-MB) were measured before operation and 24 hours after operation respectively. The levels of hypersensitive C-reactive protein (hsCRP) and neutrophil count (ANC) were measured before and 1 month after operation. Serum creatinine (Scr), blood urea nitrogen (BUN), cystatin C (CysC), alanine aminotransferase (ALT) and glutamic oxaloacetic transaminase (AST) were measured before and 24 hours after operation. The total urine volume of the two groups was recorded within 24 hours after operation.
Result
There were no significant differences in gender, age, risk factors, preoperative time, degree of coronary artery lesion, stent implantation and postoperative medication between the two groups (P 0.05).
Compared with T0, SBP, DBP and HR in group D at T1, T2, T3, T4, T5, T6 decreased significantly (P 0.05); SBP, DBP, HR in group C at T1, T2, T3, T4, T5, T6 increased significantly (P 0.05). SBP, DBP, HR in group D at T1, T2, T4, T5, T6 were significantly lower than those in group C (P 0.05).
There was no significant difference in cTnI and CK-MB between group 3C and group D before PCI (P 0.05); the peak concentrations of cTnI and CK-MB in group D after PCI were significantly lower than those in group C (P 0.05).
There was no significant difference in the concentration of hsCRP between ANC group and preoperative group (P 0.05), but the concentration of hsCRP in group D was significantly lower than that in group C 24 hours after operation (P 0.05).
There was no significant difference in LVEF and WMSI between the two groups before operation (P 0.05), but the LVEF in group D was significantly higher than that in group C (P 0.05) and the WMSI was significantly lower than that in group C (P 0.05).
Scr, BUN, CysC were significantly lower in group D than in group C (P 0.05). Scr, BUN, CysC were significantly lower in group C and group D (P 0.05). Scr, BUN, CysC, ALT and AST were significantly lower in group D than in group C (P 0.05). Scr, BUN, CysC were significantly lower in group D than in group C at 24 hours after operation (P 0.05). There was no significant difference in ALT and AST between the two groups 24 hours after operation (P 0.05). The total urine volume in group D was significantly higher than that in group C within 24 hours after operation (P 0.05).
conclusion
Intravenous Dex during PCI can produce sedation, analgesia, anti-anxiety and alleviate stress reaction in patients with AMI.
2PCI in patients with AMI Dex intravenous application, can reduce the inflammatory response of patients.
Intravenous injection of Dex in patients with AMI during 3PCI can alleviate further myocardial injury, produce myocardial protection and improve prognosis.
4Dex has a protective effect on the kidney, and has no damage to liver function, and is safe and effective.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22
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