预先选用右美托咪定与艾司洛尔在胸腔镜胸腔热灌注时对心肌的保护作用

发布时间：2018-06-06 00:47

本文选题：高温 + 诱发　；参考：《重庆医学》2017年01期

【摘要】：目的探讨麻醉前预先选择使用右美托咪定联合艾司洛尔用药在胸腔镜胸腔热灌注中对心肌保护的可行性。方法选择40例肺癌和食管癌患者应用胸腔镜下胸腔内持续热灌注治疗患者,美国麻醉医师协会(ASA)分级1~2级,分为4组,每组10例:右美托咪定联合艾司洛尔组(Y+S组),右美托咪定组(Y组),艾司洛尔组(S组),和常规生理盐水对照组(C组)。4组患者均在诱导插管前10min预先用药,Y+S组采用右美托咪定1μg/kg联合艾司洛尔0.1mg/kg缓慢静脉注射,插管后右美托咪定0.1μg·kg~(-1)·h~(-1),艾司洛尔20.0μg·kg~(-1)·h~(-1)微量泵持续输入。Y组采用右美托咪定1μg/kg,插管后以0.1μg·kg~(-1)·h~(-1)泵入;S组采用艾司洛尔0.1mg/kg,插管后以20μg·kg~(-1)·h~(-1)微量泵持续输入;C组采用相同时间点等量输注生理盐水。记录4组患者灌注开始即刻(T0),灌注30min(T1),灌注60min(T2)及术后2h(T3),术后24h(T4)各时段的肿瘤坏死因子-α(TNF-α)、心肌肌钙蛋白T(cTnI)和心肌酶谱中血清肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)的含量,同时记录两组鼻咽温度、桡动脉有创血压(MAP)、心率(HR)、脑电双频指数(BIS)、血氧饱和度(SpO_2)、动脉血氧分压(PaO_2)及呼气末二氧化碳分压(PETCO_2)以及心电图ST-T的变化和术中麻醉静脉药用量。结果与T0时刻比较,4组血清指标TNF-α、cTnI、CK、AST、LDH、CKMB值,以及鼻咽温、MAP和HR于T1时刻明显上升,T2时刻达到高峰,T4时恢复到T0水平。T1、T2、T3时刻,TNF-α浓度水平Y+S组和Y组均低于S组和C组(P0.05);cTnI、CK、AST、LDH、CKMB浓度水平Y+S组均低于Y组、S组和C组(P0.05),Y组低于S组(P0.05),S组低于C组(P0.05)。HR和MAP数值Y+S组低于Y组、S组和C组(P0.05),S组低于Y组、Y组低于C组(P0.05)。ST-T数值4组均有压低改变,Y+S组压低值最小(P0.05),Y组较C组压低值小(P0.05),S组较Y组压低值小(P0.05)。BIS值T0、T1时刻Y+S组和Y组均低于S组和C组(P0.05)。结论预先选择使用右美托咪定联合艾司洛尔联合用药能减轻胸腔镜下胸腔内热灌注对心肌的损害,起到更好的心肌保护作用。
[Abstract]:Objective to investigate the feasibility of pre selective use of dexmedetomidin and esmolol in the protection of the myocardium during thoracoscopic hot pleural perfusion. Methods 40 patients with lung and esophageal cancer were treated by thoracoscopic continuous thermal perfusion in thoracic cavity, and the American Association of anesthesiologists (ASA) was classified into 4 groups, and 10 patients in each group were divided into 4 groups. Dexmedetomidine combined with esmolol group (group Y+S), right metoimidin group (group Y), esmolol group (group S), and normal saline control group (group C) group.4 patients were pretreated before intubation 10min, Y+S group adopted right metomomidin 1 u g/kg combined with esmolol 0.1mg/kg slow intravenous injection, right metomomidine after intubation, 0.1 mu kg~ (-1). ~ (-1), esmolol 20 mu g. Kg~ (-1). H~ (-1) micropump continued to enter the.Y group with right metomomidin 1 u g/kg, after intubation, 0.1 u g kg~ (-1) and h~ (-1) were pumped. Starting immediate (T0), perfusion of 30min (T1), perfusion of 60min (T2) and postoperative 2H (T3), tumor necrosis factor alpha (TNF- a) at every time of 24h (T4), serum creatine kinase in cardiac troponin T (cTnI) and myocardial enzyme spectrum, content of creatine kinase isoenzyme, aspartate aminotransferase, lactate dehydrogenase, and two groups at the same time Nasopharyngeal temperature, radial arterial blood pressure (MAP), heart rate (HR), bispectral index (BIS), oxygen saturation (SpO_2), arterial oxygen pressure (PaO_2) and end expiratory carbon dioxide partial pressure (PETCO_2), the changes of ST-T in the electrocardiogram and the dosage of anesthetic intravenous drug during the operation. The results were compared with the time of T0, the 4 groups of serum indexes TNF- alpha, cTnI, CK, AST, AST, values, and At the temperature of nasopharynx, MAP and HR increased obviously at the time of T1, and the time of T2 reached the peak. When T4 returned to T0 level.T1, T2, T3 moment, TNF- alpha concentration level and Y group were lower than those of the group and Y group. In group Y, group S and group C (P0.05), group S was lower than group Y, Y group was lower than group C (P0.05).ST-T value of 4 groups, and Y+S group was lower (P0.05). The combination of lol can reduce the damage of myocardium caused by intrapleural hyperthermic perfusion under thoracoscope and play a better role in myocardial protection.
【作者单位】：河北省邯郸市中心医院麻醉科;河北省邯郸职业技术学院门诊部;
【分类号】：R614

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