摘要
目的 评价右美托咪啶对冠心病患者非心脏手术期间的心肌保护效应.方法 选择行上腹部手术的冠心病患者80例,性别不限,年龄43～76岁,体重52～80 kg,ASA分级Ⅱ或Ⅲ级,NYHA 分级Ⅱ或Ⅲ级,采用随机数字表法,将患者随机分为2组（n=40）：对照组（C组）和右美托咪啶组（D组）.D组麻醉诱导前10 min静脉注射右美托咪啶负荷剂量1μg/kg,继之以0.4μg·kg-1·h-1的速率维持至术毕,C组给予等容量生理盐水.两组术中维持BIS值40～49.于麻醉诱导前和术毕时取血样,测定血清IL-6、TNF-α、cTnI和糖原磷酸化酶BB（GP-BB）的浓度,记录术中心血管不良反应的发生情况.结果 与C组比较,D组血清IL-6、,TNF-α、cTnI及GP-BB水平明显降低,心动过缓发生率升高,心动过速和心肌缺血发生率降低（P〈0.05）.结论 右美托咪啶对冠心病患者非心脏手术期间可产生心肌保护效应,其机制可能与抑制促炎性细胞因子释放有关.
Objective To evaluate the myocardial protective effect of dexmedetomidine during non-cardiac surgery in patients with coronary heart disease.Methods Eighty ASAⅡor Ⅲ patients with coronary heat disease （NYHA Ⅱ or Ⅲ）aged 43-76 yr weighing 52-80 kg scheduled for elective upper abdominal surgery were randomly divided into 2 groups（n=40 each）：control group（group C）and dexmedetomidine group（group D）.Anesthesia was induced with etomidate 0.25 mg／kg，sufentanil 0.5 μg／kg and vecuronium 0.1 mg／kg.The patients were tracheal intubated and mechanically ventilated.A loading dose of dexmedetomidine 1μg/kg was injected intravenously 10 min before induction followed by infusion at 0.4 μg·kg-1·h-1 until the end of operation in group D.While equal volume of normal saline was given in group C.BIS was maintained at 40-49.Blood samples were taken before induction and at the end of operation for determination of serum concenlrations of IL-6，TNF-α，cardiac troponin Ⅰ（cTnI）and glycogen phosphorylase BB（GP-BB）.The adverse cardiovascular events were recorded during operation.Results The serum concentrations of IL-6，TNF-α，cTnI and GP-BB and incidences of tachycardia and myocardial ischemia were significantly lower，while the incidences of bradycardia highcr in group D than in group C （P〈0.05）.Conclusion Dexmedetomidine Can exert the myocardial protective effect during non-cardiac surgery in patients with coronary heart disease and the mechanism may be related to the inhibition of the release of pro-inflammatory cytokines.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2011年第2期160-162,共3页
Chinese Journal of Anesthesiology
关键词
右美托咪啶
冠心病
心肌
Dexmedetomidine
Coronary disease
Myocardium
