CAJ | 학술논문

目的评价右美托咪定对合并肺动脉高压患者二尖瓣置换术时血流动力学和心肌损伤的影响.方法择期行二尖瓣置换术的肺动脉高压患者40例,年龄18 ～64岁,性别不限,体重45～75 kg,ASA分级Ⅱ或Ⅲ级.采用随机数字表法,将其分为2组(n=20):对照组(C组)和右美托咪定组(D组).气管插管后D组经10 min静脉注射右美托咪定负荷量1μg/kg,随后以0.5 μg·kg-·h-1速率输注至术毕,C组输注等容量生理盐水.麻醉诱导后气管插管,机械通气,采用静吸复合麻醉,维持Narcotrend指数值40～50.分别于给予右美托眯定前即刻、停CPB后10 min、术毕、术后6、24h时采集中心静脉血样,测定血浆CK-MB和cTnI的水平.于右美托眯定给药前后、切皮时、劈胸骨时、CPB前后及手术结束时,采用Swan-Ganz导管及VigilanceⅡ血液动力学监测系统测定HR、MAP、肺动脉平均压(MPAP)、心排量(CO)、外周循环阻力(SVR)、肺循环阻力(PVR).记录术中血管活性药物应用情况和心脏自动复跳情况.结果 D组各血流动力学指标在切皮、劈胸骨手术刺激时维持稳定,CPB后MPAP下降并维持在较低水平.与C组比较,D组血浆CK-MB及cTnI水平、术中去氧肾上腺素用量、多巴胺用量及肾上腺素使用率降低(P＜0.05),米力农用量和心脏自动复跳率差异无统计学意义(P＞0.05).结论合并肺动脉高压患者二尖瓣置换术中,静脉注射右美托咪定负荷量1 μg/kg,随后以0.5 μg·kg-·h-1速率输注右美托咪定,有助于维持体循环和肺循环的稳定,且产生一定程度的心肌保护作用.
목적 평개우미탁미정대합병폐동맥고압환자이첨판치환술시혈류동역학화심기손상적영향.방법 택기행이첨판치환술적폐동맥고압환자40례,년령18 ～64세,성별불한,체중45～75 kg,ASA분급Ⅱ혹Ⅲ급.채용수궤수자표법,장기분위2조(n=20):대조조(C조)화우미탁미정조(D조).기관삽관후D조경10 min정맥주사우미탁미정부하량1μg/kg,수후이0.5 μg·kg-·h-1속솔수주지술필,C조수주등용량생리염수.마취유도후기관삽관,궤계통기,채용정흡복합마취,유지Narcotrend지수치40～50.분별우급여우미탁미정전즉각、정CPB후10 min、술필、술후6、24h시채집중심정맥혈양,측정혈장CK-MB화cTnI적수평.우우미탁미정급약전후、절피시、벽흉골시、CPB전후급수술결속시,채용Swan-Ganz도관급VigilanceⅡ혈액동역학감측계통측정HR、MAP、폐동맥평균압(MPAP)、심배량(CO)、외주순배조력(SVR)、폐순배조력(PVR).기록술중혈관활성약물응용정황화심장자동복도정황.결과 D조각혈류동역학지표재절피、벽흉골수술자격시유지은정,CPB후MPAP하강병유지재교저수평.여C조비교,D조혈장CK-MB급cTnI수평、술중거양신상선소용량、다파알용량급신상선소사용솔강저(P＜0.05),미력농용량화심장자동복도솔차이무통계학의의(P＞0.05).결론 합병폐동맥고압환자이첨판치환술중,정맥주사우미탁미정부하량1 μg/kg,수후이0.5 μg·kg-·h-1속솔수주우미탁미정,유조우유지체순배화폐순배적은정,차산생일정정도적심기보호작용.
Objective To investigate the effects of dexmedetomdine on hemodynamics and myocardial injury in patients with pulmonary hypertension undergoing mitral valve replacement.Methods Forty ASA Ⅱ or Ⅲ patients with pulmonary hypertension,aged 18-64 yr,undergoing mitral valve replacement,were randomized into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv midazolam 0.05 mg/kg,sufentanil 1 μg/kg,etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg and maintained with combined intravenous-inhalational anesthesia.Narcotrend index values were maintained at 40-50.The patients were tracheal intubated and mechanically ventilated.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min after intubation followed by infusion at 0.5 μg· kg-1· h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Venous blood samples were taken immediately before dexmedetomidine administration,at 10 min after termination of cardiopulmonary bypass (CPB),at the end of operation,and at 6 and 24 h after operation for determination of plasma levels of creatine kinase MB (CK-MB) and cardiac troponin Ⅰ (cTnI) by ELISA.Before and after administration of dexmedetomidine,at skin incision,at sternum splitting,before and after CPB,and at the end of operation,HR,MAP,mean pulmonary arterial pressure (MPAP),cardiac output (CO),systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were detected by using Swan-Ganz catheter and Vigilance Ⅱ monitor.The requirement for vasoactive drugs and condition of spontaneous heart beats were recorded.Results In group D,each hemodynamic parameter was maintained stable at skin incision and sternum splitting,and MPAP was decreased after CPB and maintained at a lower level.The plasma levels of CK-MB and cTnI,consumption of phenylephrine and dopamine,and requirement for epinephrine were significantly lower in group D than in group C (P ＜ 0.05).There was no significant difference in the consumption of milrinone and rate of spontaneous heart beat between the two groups (P ＞ 0.05).Conclusion During mitral valve replacement for patients with pulmonary hypertension,dexmedetomidine infused at 0.05 μg·kg-1· h-1 after a loading dose of 1 μg/kg is helpful in maintaining systemic circulation and pulmonary circulation stable and provides myocardial protection to some extent.