右美托咪定用于中老年患者体外循环下心脏瓣膜置换手术心肌保护作用的评估

发布时间：2018-03-24 18:08

本文选题：右美托咪定　切入点：瓣膜置换　出处：《实用医学杂志》2015年23期

【摘要】：目的:以心型脂肪酸结合蛋白(H-FABP),肌酸激酶同工酶(CK-MB)和肌钙蛋白I(c Tn I)评估右美托咪定对中老年患者体外循环(CPB)下心脏瓣膜置换手术心肌的保护作用。方法:选择本院50例41~72岁CPB下换瓣手术患者,随机均等分为生理盐水组(C组)和右美托咪定组(D组)。D组诱导前15 min以右美托咪定1μg/(kg·h)恒速泵注,随之以0.5μg/(kg·h)恒速泵注至手术结束;C组患者静脉恒速泵注等量生理盐水,其余麻醉处理相同。检测静注右美前(T0),CPB建立时(T1),CPB结束后(T2),手术结束时(T3),术后12、24 h(T4、T5)颈内静脉血心肌损伤标记物H-FABP、CK-MB、c Tn I的浓度。结果 :D组患者血压和心率在T1~T5时段较C组波动明显小(P0.05)。两组患者术中H-FABP、CK-MB和c Tn I均增高,D组患者H-FABP在T2~T4时点均明显小于C组(P0.05),而CK-MB和c Tn I在T3~T5时点均明显小于C组(P0.05)。结论:右美托咪定可降低中老年患者CPB心脏瓣膜置换术围术期循环波动和心肌损伤。
[Abstract]:Objective: to evaluate the protective effect of dexmetomidine on cardiac valve replacement in middle-aged and elderly patients with cardiopulmonary bypass (CPB) by cardiac fatty acid binding protein (H-FABPN), creatine kinase isoenzyme (CK-MBB) and troponin I (c Tn I). 50 patients (41 ~ 72 years old) underwent valve replacement under CPB in our hospital. They were randomly divided into normal saline group (group C) and dexmetomidine group (group D). Group D was injected with dexmetomidine 1 渭 g/(kg / h at 15 min before induction, followed by intravenous infusion of the same amount of normal saline with constant speed pump (0.5 渭 g/(kg / h) until the end of operation. The other anesthetic treatments were the same. The concentration of H-FABP- CK-MBC / Tn I, a marker of myocardial injury in jugular vein blood, was detected at the time of establishment of dextromethamine T0 and T _ (1) and T _ (3) at the end of operation and 12 h after operation. Results the blood pressure and heart rate of patients in group D were in T1~T5 period. The H-FABP of group D was significantly lower than that of group C at T2~T4 time, and that of CK-MB and cTnI was significantly lower than that of group C at T3~T5 time. Conclusion: dexmetomidine can be decreased. Perioperative circulation fluctuation and myocardial injury in elderly patients with CPB valve replacement.
【作者单位】：海南省农垦三亚医院;中山大学附属第一医院;
【基金】：广东省自然科学基金(编号:s2012010010965)
【分类号】：R614

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