CAJ | 학술논문

目的：观察右美托咪定（dexmedetomidine， DEX）对二尖瓣置换术患者心肌的保护作用。方法入选的48例患者随机分为两组：DEX组（ D组，25例）和生理盐水组（ C组，23例）。D组给予DEX负荷量（0．5μg／kg，10 min泵注），泵注结束后开始麻醉诱导，并以0．5μg／（kg· h） DEX维持至手术结束；C组相同的方法泵注等容量的生理盐水。两组分别在麻醉诱导前（ T0）、麻醉诱导后切皮前（T1）、体外循环开始时（T2）、体外循环结束时（T3）、停机后6 h（T4）5个时间点记录心率（HR）、平均动脉压（MAP）。在T1、T3、T4、停机后12 h（T5）、停机后24 h（T6）5个时间点采集血样测定血清肌钙蛋白I（cTnI）和缺血修饰白蛋白（IMA）。观察并记录两组患者手术时间、体外循环时间、主动脉阻闭时间、术后住院时间、心脏自动复跳率等临床指标。结果 D组在T1、T2时MAP明显高于C组（P＜0．05）。 D组在T1、T2时HR明显低于C组（P＜0．05）。 D组在T3、T4、T5、T6时cTnI水平均明显低于C组（ P＜0．05）。 D组IMA在T3、T4时明显低于C组（ P＜0畅05）。 D组自动复跳率明显高于C组（ P＜0．05）。结论 DEX能够稳定血流动力学，减轻二尖瓣置换术患者围术期心肌损伤，对心肌具有一定保护作用。
목적：관찰우미탁미정（dexmedetomidine， DEX）대이첨판치환술환자심기적보호작용。방법입선적48례환자수궤분위량조：DEX조（ D조，25례）화생리염수조（ C조，23례）。D조급여DEX부하량（0．5μg／kg，10 min빙주），빙주결속후개시마취유도，병이0．5μg／（kg· h） DEX유지지수술결속；C조상동적방법빙주등용량적생리염수。량조분별재마취유도전（ T0）、마취유도후절피전（T1）、체외순배개시시（T2）、체외순배결속시（T3）、정궤후6 h（T4）5개시간점기록심솔（HR）、평균동맥압（MAP）。재T1、T3、T4、정궤후12 h（T5）、정궤후24 h（T6）5개시간점채집혈양측정혈청기개단백I（cTnI）화결혈수식백단백（IMA）。관찰병기록량조환자수술시간、체외순배시간、주동맥조폐시간、술후주원시간、심장자동복도솔등림상지표。결과 D조재T1、T2시MAP명현고우C조（P＜0．05）。 D조재T1、T2시HR명현저우C조（P＜0．05）。 D조재T3、T4、T5、T6시cTnI수평균명현저우C조（ P＜0．05）。 D조IMA재T3、T4시명현저우C조（ P＜0창05）。 D조자동복도솔명현고우C조（ P＜0．05）。결론 DEX능구은정혈류동역학，감경이첨판치환술환자위술기심기손상，대심기구유일정보호작용。
Objective To observe the protective effect of dexmedetomidine ( DEX ) on myocardium in patients with mitral valve replacement .Methods The selected patients were randomly divided into two groups:group DEX (group D, 25 cases) and saline group (group C, 23 cases).D group was given DEX load (0.5 g/kg, l0 min injection pump), start induction of anesthesia after pump, and 0.5 g/( kg· h) DEX until the end of operation .Group C used saline the same way pumping capacity.Heart rate (HR), mean arterial pressure (MAP) of the two groups were recorded at 5 time points:before induction of anesthesia (T0), after induction of anesthesia, before skin incision (T1), the beginning of cardiopulmonary bypass ( T2 ) , at the end of CPB ( T3 ) , 6 h after operation ( T4 ) . Blood samples were collected for determination of serum troponin I ( cTnI ) and ischemia modified albumin (IMA) in the T1, T3, T4, 12 h after operation (T5), 24 h after operation (T6) 5 time points.Operation time, cardiopulmonary bypass time, aortic blocking time, postoperative hospitalization time, automatic rebeating rate and other clinical indicators between the two groups were also recorded . Results MAP in group D before skin incision ( T1 ) , the beginning of cardiopulmonary bypass ( T2 ) while was higher than that in group C , the difference was statistically significant ( P<0.05 ) .HR in group D before skin incision ( T1 ) , the beginning of cardiopulmonary bypass ( T2 ) was significantly lower than that in C group, the difference was statistically significant (P<0.05).The cTnI levels of D group at the end of CPB ( T3 ) , 6 h after operation ( T4 ) , 12 h ( T5 ) , 24 h ( T6 ) were significantly lower than those in C group, the difference was statistically significant (P<0.05).IMA of group D at the end of CPB ( T3 ) , 6 h after operation ( T4 ) was significantly lower than that in C group , the difference was statistically significant (P<0.05).Automatic rebeating rate in D group was significantly higher than that of C group , the difference was statistically significant ( P <0 .05 ) .Conclusion Dexmedetomidine can stabilize the hemodynamics , reduce myocardial injury during perioperative period in patients with mitral valve replacement , has certain protective effect on myocardial .