不同剂量右美托咪定对心肺转流风心瓣膜置换术患者心肌损伤的影响

发布时间：2018-07-04 16:34

本文选题：风湿性心脏病 + 右美托咪定　；参考：《重庆医学》2015年04期

【摘要】：目的比较不同剂量右美托咪定对心肺转流(CPB)风心瓣膜置换术患者围术期心肌损伤的影响。方法随机、双盲将择期风心二尖瓣狭窄瓣膜置换术患者分为3组:对照组(C组)、低剂量右美托咪定组(DEX1组)、高剂量右美托咪定组(DEX2组)。3组患者分别于全身麻醉诱导前(T0)、CPB后2h(T1)、CPB后24h(T2)、CPB后48h(T3)、CPB后72h(T4)抽取患者中心静脉血,监测各时点血浆肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)水平、平均动脉压(MAP)和心率(HR)的变化。并记录气管导管拔除时间、ICU停留时间、术后24h时心肌收缩力评分、术后24h引流量、心脏自动复跳及心血管不良事件发生的情况。结果与T0相比,DEX2组HR在T1时间点明显降低。与C组相比,DEX1组在T1时间点HR、血浆CK-MB明显降低,术后24h时心肌收缩力评分和心血管不良事件发生率显著降低(P0.05),但心脏自动复跳率没有明显改善;DEX2组在T1时间点HR显著减少,在T1和T2时间点血浆CK-MB值明显降低,在T2~T4时间点血浆cTnI值显著减少,心脏自动复跳率明显增加,术后24h时心肌收缩力评分和心血管不良事件发生率明显降低(P0.05);DEX1组和DEX2组的气管导管拔除时间、ICU停留时间和术后24h引流量没有明显变化。结论右美托咪定对风心瓣膜置换术患者围术期心肌损伤具有保护作用,负荷量0.6μg/kg继之以0.6μg·kg-1·h-1输注的给药方法更佳。
[Abstract]:Objective to compare the effects of dexmetidine on perioperative myocardial injury in patients undergoing cardiopulmonary bypass (CPB) with wind valve replacement. Methods Random, Patients undergoing elective mitral valve replacement were divided into three groups: control group (group C), low-dose dextromidine group (DEX1 group) and high-dose dexmetomidine group (DEX2 group). 3 patients were treated with CPB 2 hours after general anesthesia induction (T0). 48 h after CPB (T2) and 72 h after CPB (T 4), the central venous blood was extracted. Plasma troponin I (cTnI), creatine kinase isoenzyme (CK-MB), mean arterial pressure (map) and heart rate (HR) were measured. The withdrawal time of trachea catheter and the duration of stay in ICU, the score of cardiac contractility at 24 hours after operation, the drainage flow at 24 hours after operation, the automatic cardiac resuscitation and the occurrence of adverse cardiovascular events were recorded. Results compared with T 0, HR of DEX 2 group decreased significantly at T 1 time point. Compared with group C, plasma CK-MB was significantly decreased, myocardial contractility score and incidence of cardiovascular adverse events were significantly decreased at 24 hours after operation (P0.05), but cardiac automatic heart rebeat rate was not significantly improved in DEX1 group at T1 time point, but HR decreased significantly in DEX2 group at T1 time point. At T1 and T2, plasma CK-MB decreased significantly, and plasma cTnI decreased at T2T4. The cardiac contractility score and the incidence of cardiovascular adverse events were significantly decreased at 24 hours after operation (P0.05) the extubation time of trachea in DEX1 group and DEX2 group had no significant change in ICU residence time and drainage flow 24 hours after operation. Conclusion dexmetomidine has protective effect on perioperative myocardial injury in patients with rheumatic valve replacement, and 0.6 渭 g/kg loading dose followed by 0.6 渭 g kg-1 h-1 infusion is better.
【作者单位】：安徽医科大学第一附属医院麻醉科;蚌埠医学院第一附属医院;
【分类号】：R614

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