摘要
目的 观察术中泵注右美托咪定对老年患者腹部手术后心肌损伤的影响。方法 选择2022年3月至2023年1月行腹部手术的老年患者117例,男61例,女56例,年龄65~85岁,BMI17.0~26.0 kg/m^(2),ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组:右美托咪定组(D组,n=58)和对照组(C组,n=59)。D组术中持续泵注右美托咪定0.4μg·kg^(-1)·h^(-1),C组泵注等容量生理盐水。记录术中窦性心动过缓持续时间、七氟醚用量和术后心肌损伤发生情况。记录术前5 min、术后24、48 h血浆高敏肌钙蛋白T(hs-cTnT)、N端脑钠肽前体(NT-proBNP)浓度。记录术前5 min和术后24 h血浆肾上腺素(AD)、去甲肾上腺素(NE)、皮质醇(Cor)、总抗氧化物(T-AOC)、高敏C-反应蛋白(hs-CRP)和前白蛋白(PA)浓度。记录术后24、48 h静息和活动时VAS疼痛评分、镇痛泵总按压次数、有效按压次数、补救镇痛例数。记录术后48 h内胸闷、心慌、气短、腿肿的发生情况。结果 与C组比较,D组术中窦性心动过缓持续时间明显延长,七氟醚用量明显减少,心肌损伤发生率明显降低,术后48 h血浆hs-cTnT、NT-proBNP浓度明显降低,术后24 h血浆AD、NE、Cor和hs-CRP浓度明显降低、T-AOC和PA浓度明显升高,术后24、48 h活动时VAS疼痛评分明显降低,镇痛泵总按压次数和有效按压次数明显减少,补救镇痛率明显降低(P<0.05)。两组不良反应差异无统计学意义。结论 术中泵注右美托咪定能减轻老年患者腹部手术后心肌损伤,其机制可能与术中减慢心率、减少术中七氟醚用量、减轻氧化应激损伤、改善术后镇痛效果有关。
Objective To observe the effects of intraoperative dexmedetomidine infusions on postoperative myocardial injury after abdominal surgery in elderly patients.Methods A total of 117 elderly patients who were scheduled to undergo abdominal surgery from March 2022 to January 2023 were selected,61 males and 56 females,aged 65-85 years,BMI 17.0-26.0 kg/m^(2),ASA physical statusⅡorⅢ.The patients were divided into two groups by the random number table method:the dexmedetomidine group(group D,n=58)and the control group(group C,n=59).In group D,dexmedetomidine was continuously infused at a dose of 0.4μg·kg^(-1)·h^(-1) during the operation,while in group C,the same amount of normal saline was infused.The duration of sinus bradycardia during the operation,the dosage of sevoflurane and the occurrence of myocardial injury after surgery were recorded.The concentrations of plasma high-sensitivity troponin T(hs-cTnT)and N-terminal pro-brain natriuretic peptide(NT-proBNP)5 minutes before surgery,24 and 48 hours after surgery were recorded.The concentrations of plasma epinephrine(AD),norepinephrine(NE),cortisol(Cor),total antioxidants(T-AOC),high-sensitivity C-reactive protein(hs-CRP),and prealbumin(PA)5 minutes before surgery and 24 hours after surgery were recorded.VAS pain scores at rest and during activity 24 and 48 hours after surgery,the total number of compressions of the analgesic pump,the effective number of compressions,and the number of cases of remedial analgesia were recorded.The occurrence of chest tightness,palpitations,shortness of breath and leg swelling within 48 hours postoperatively were recorded.Results Compared with group C,the duration of sinus bradycardia during the operation was significantly prolonged,the dosage of sevoflurane was significantly reduced,the incidence of myocardial injury was significantly decreased,and the concentrations of plasma hs-cTnT and NT-proBNP 48 hours after surgery were significantly decreased.The concentrations of plasma AD,NE,Cor,and hs-CRP 24 hours after the operation were significantly decreased,while the concentrations of T-AOC and PA were significantly increased,the VAS pain score during activity 24 and 48 hours after surgery,the total number of compressions of the analgesic pump,the effective number of compressions,and the rate of remedial analgesia were significantly decreased in group D(P<0.05).Conclusion Intraoperative infusions of dexmedetomidine can alleviate myocardial injury in elderly patients after abdominal surgery.The mechanism may be related to intraoperative heart rate reduction,intraoperative sevoflurane dosage reduction,reduction of excessive oxidative stress level,and improvement of postoperative analgesic effect.
作者
徐钊
伊敏敏
田紫薇
张存瑶
张博睿
杨瑞
姚波
常建华
XU Zhao;YI Minmin;TIAN Ziwei;ZHANG Cunyao;ZHANG Borui;YANG Rui;YAO Bo;CHANG Jianhua(Department of Anesthesiology,Shaanxi Provincial People's Hospital,Xi'an 710068,China)
出处
《临床麻醉学杂志》
北大核心
2025年第10期1035-1039,共5页
Journal of Clinical Anesthesiology
基金
陕西省重点研发计划(2024SF-YBXM-054)
陕西省人民医院科技发展孵化基金项目(2023YJY-48)
陕西省人民医院科技人才支持计划(2023JY-26)。
关键词
右美托咪定
老年
腹部手术
心肌损伤
氧化应激
Dexmedetomidine
Aged
Abdominal surgery
Myocardial injury
Oxidative stress
