中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
8期
933-936
,共4页
右美托咪啶%咪达唑仑%冠状动脉%支架%心肌再灌注损伤%心肌梗塞%清醒镇静
右美託咪啶%咪達唑崙%冠狀動脈%支架%心肌再灌註損傷%心肌梗塞%清醒鎮靜
우미탁미정%미체서륜%관상동맥%지가%심기재관주손상%심기경새%청성진정
Dexmedetomidine%Midazolam%Coronary artery%Stent%Myocardial reperfusion injury%Myocardial Infarction%Conscious sedation
目的 比较右美托咪定与咪达唑仑镇静对经皮冠状动脉介入治疗(PCI)患者的心肌保护效应.方法 选择急性心肌梗死需行急诊PCI患者60例,性别不限,ASA分级Ⅲ或Ⅳ级,年龄41～88岁,体重45 ～ 85 kg,采用随机数字表法,将患者分为2组(n=30):右美托咪定组(D组)和咪达唑仑组(M组).D组于术前静脉输注右美托咪定负荷剂量1 μg/kg,输注时间10 min,M组术前静脉注射咪达唑仑0.05 mg/kg,两组术中分别静脉泵注右美托咪定0.2～ 1.4 μg·kg-1·h-1和咪达唑仑0.02 ～ 0.10mg· kg-1 ·h-1至手术结束,根据RASS镇静程度评估表,维持RASS-2-2.于给药前及术后第3天行心脏彩色多普勒超声,记录左心室射血分数(LVEF),采集肘静脉血,测定血清心肌酶和心肌肌钙蛋白Ⅰ(cTnI)水平,记录手术并发症发生情况、ICU停留时间及住院时间.结果 与M组比较,D组术后第3天血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、谷草转氨酶(AST)及乳酸脱氢酶(LDH)的活性和cTnI浓度降低,LVEF升高,ICU停留时间及住院时间缩短(P＜0.05);两组术后并发症发生情况差异无统计学意义(P＞0.05).结论 与咪达唑仑比较,右美托咪定镇静对PCI患者心肌保护效应及预后效果更佳,更适合PCI患者的镇静.
目的 比較右美託咪定與咪達唑崙鎮靜對經皮冠狀動脈介入治療(PCI)患者的心肌保護效應.方法 選擇急性心肌梗死需行急診PCI患者60例,性彆不限,ASA分級Ⅲ或Ⅳ級,年齡41～88歲,體重45 ～ 85 kg,採用隨機數字錶法,將患者分為2組(n=30):右美託咪定組(D組)和咪達唑崙組(M組).D組于術前靜脈輸註右美託咪定負荷劑量1 μg/kg,輸註時間10 min,M組術前靜脈註射咪達唑崙0.05 mg/kg,兩組術中分彆靜脈泵註右美託咪定0.2～ 1.4 μg·kg-1·h-1和咪達唑崙0.02 ～ 0.10mg· kg-1 ·h-1至手術結束,根據RASS鎮靜程度評估錶,維持RASS-2-2.于給藥前及術後第3天行心髒綵色多普勒超聲,記錄左心室射血分數(LVEF),採集肘靜脈血,測定血清心肌酶和心肌肌鈣蛋白Ⅰ(cTnI)水平,記錄手術併髮癥髮生情況、ICU停留時間及住院時間.結果 與M組比較,D組術後第3天血清肌痠激酶(CK)、肌痠激酶同工酶(CK-MB)、穀草轉氨酶(AST)及乳痠脫氫酶(LDH)的活性和cTnI濃度降低,LVEF升高,ICU停留時間及住院時間縮短(P＜0.05);兩組術後併髮癥髮生情況差異無統計學意義(P＞0.05).結論 與咪達唑崙比較,右美託咪定鎮靜對PCI患者心肌保護效應及預後效果更佳,更適閤PCI患者的鎮靜.
목적 비교우미탁미정여미체서륜진정대경피관상동맥개입치료(PCI)환자적심기보호효응.방법 선택급성심기경사수행급진PCI환자60례,성별불한,ASA분급Ⅲ혹Ⅳ급,년령41～88세,체중45 ～ 85 kg,채용수궤수자표법,장환자분위2조(n=30):우미탁미정조(D조)화미체서륜조(M조).D조우술전정맥수주우미탁미정부하제량1 μg/kg,수주시간10 min,M조술전정맥주사미체서륜0.05 mg/kg,량조술중분별정맥빙주우미탁미정0.2～ 1.4 μg·kg-1·h-1화미체서륜0.02 ～ 0.10mg· kg-1 ·h-1지수술결속,근거RASS진정정도평고표,유지RASS-2-2.우급약전급술후제3천행심장채색다보륵초성,기록좌심실사혈분수(LVEF),채집주정맥혈,측정혈청심기매화심기기개단백Ⅰ(cTnI)수평,기록수술병발증발생정황、ICU정류시간급주원시간.결과 여M조비교,D조술후제3천혈청기산격매(CK)、기산격매동공매(CK-MB)、곡초전안매(AST)급유산탈경매(LDH)적활성화cTnI농도강저,LVEF승고,ICU정류시간급주원시간축단(P＜0.05);량조술후병발증발생정황차이무통계학의의(P＞0.05).결론 여미체서륜비교,우미탁미정진정대PCI환자심기보호효응급예후효과경가,경괄합PCI환자적진정.
Objective To compare dexmedetomidine versus midazolam sedation for myocardial protection in the patients undergoing percutaneous coronary intervention (PCI).Methods Sixty patients with acute myocardial infarction who required for emergency PCI,were selected and randomly divided into 2 groups (n =30 each) using a random number table:dexmedetomidine group (group D) and midazolam group (group M).In group D,a loading dose of dexmedetomidine 1 μg/kg was infused intravenously for 10 min before surgery.In group M,midazolam 0.05 mg/kg was injected intravenously before surgery.Dexmedetomidine 0.2-1.4 μg· kg-1 · h-1 and midazolam 0.02-0.10 mg·kg-1 ·h-1 were given via a pump during surgery until the end of surgery in the two groups.The RASS score was maintained at-2-2 in two groups.Before administration and on 3rd day after surgery,cardiovascular color doppler ultrasound was performed to record left ventricular ejection fraction (LVEF),venous blood samples were collected for determination of the levels of serum myocardial enzyme and cardiac troponin I (cTnI),and the development of surgical complications,duration of ICU stay and length of hospital stay were recorded.Results Compared with group M,the activities of serum creatine kinase,creatine kinase isoenzyme-MB,aspartate amino transferase and lactic dehydrogenase and cTnI concentrations were significantly decreased,LVEF was increased,and duration of ICU stay and length of hospital stay were shortened in group D.There was no significant difference in the development of postoperative complications between the two groups.Conclusion Dexmedetomidine sedation provides better efficacy for myocardial protection and prognosis and is more suitable for sedation than midazolam in the patients undergoing PCI.
