CAJ | 학술논문

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.
목적 평개우미탁미정대관심병환자비심장수술기간적심기보호효응.방법 선택행상복부수술적관심병환자80례,성별불한,년령43～76세,체중52～80 kg,ASA분급Ⅱ혹Ⅲ급,NYHA 분급Ⅱ혹Ⅲ급,채용수궤수자표법,장환자수궤분위2조(n=40):대조조(C조)화우미탁미정조(D조).D조마취유도전10 min정맥주사우미탁미정부하제량1μg/kg,계지이0.4μg·kg-1·h-1적속솔유지지술필,C조급여등용량생리염수.량조술중유지BIS치40～49.우마취유도전화술필시취혈양,측정혈청IL-6、TNF-α、cTnI화당원린산화매BB(GP-BB)적농도,기록술중심혈관불량반응적발생정황.결과 여C조비교,D조혈청IL-6、,TNF-α、cTnI급GP-BB수평명현강저,심동과완발생솔승고,심동과속화심기결혈발생솔강저(P<0.05).결론 우미탁미정대관심병환자비심장수술기간가산생심기보호효응,기궤제가능여억제촉염성세포인자석방유관.
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.