CAJ | 학술논문

目的：探讨右美托咪定对胃肠道肿瘤患者腹腔热灌注化疗（IPHC）围术期的心肌保护作用。方法选择邯郸市中心医院2014年5月—2015年5月收治的行胃肠癌根治术的胃肠道肿瘤患者48例，均在胃肠癌根治术后行IPHC，采用随机数字表法分为高剂量右美托咪定组（D1组）、低剂量右美托咪定组（D2组）和对照组（C 组），每组16例。麻醉诱导前，D1组和 D2组患者分别静脉泵注右美托咪定1μg/ kg 负荷量，诱导后再分别匀速静脉泵注右美托咪定0.5μg·kg -1·h -1（D1组）和0.2μg·kg -1·h -1（D2组）至手术结束前30 min；C 组采用同样方法静脉泵注等量0.9%氯化钠溶液。比较3组患者灌注前10 min（T1）、灌注开始后30 min（T2）、60 min（T3）及灌注结束后30 min（T4）血流动力学指标〔包括心率（HR）、平均动脉压（MAP）及血氧饱和度（SpO2）〕；比较3组患者 T1、T2、T3、T4及术后24 h（T5）、72 h（ T6）心肌酶学指标〔包括血清肌酸激酶同工酶（ CK - MB）和心肌肌钙蛋白 I （cTnI）水平〕。结果3组患者 T1时 HR 和 MAP 及 T1、T2、T3、T4时 SpO2比较，差异均无统计学意义（P ﹥0.05）；T2、T3、T4时 D1和 D2组患者 HR 低于 C 组、D1组患者 MAP 低于 C 组，T3时 D2组患者 MAP 低于 C 组（P ﹤0.05）。T1、T3及 T6时3组患者血清 CK - MB 水平比较，差异无统计学意义（P ﹥0.05）；T4、T5时 D1组和 D2组患者血清CK - MB 水平低于 C 组，D1组患者血清 CK - MB 水平低于 D2组（P ﹤0.05）。T1、T3时3组患者血清 cTnI 水平比较，差异无统计学意义（P ﹥0.05）；T4、T5、T6时 D1组和 D2组患者血清 cTnI 水平低于 C 组，T4、T5时 D1组患者血清cTnI 水平低于 D2组（P ﹤0.05）。结论右美托咪定对胃肠道肿瘤患者 ICPH 围术期心肌具有保护作用，且高剂量右美托咪定的心肌保护作用更强。
목적：탐토우미탁미정대위장도종류환자복강열관주화료（IPHC）위술기적심기보호작용。방법선택함단시중심의원2014년5월—2015년5월수치적행위장암근치술적위장도종류환자48례，균재위장암근치술후행IPHC，채용수궤수자표법분위고제량우미탁미정조（D1조）、저제량우미탁미정조（D2조）화대조조（C 조），매조16례。마취유도전，D1조화 D2조환자분별정맥빙주우미탁미정1μg/ kg 부하량，유도후재분별균속정맥빙주우미탁미정0.5μg·kg -1·h -1（D1조）화0.2μg·kg -1·h -1（D2조）지수술결속전30 min；C 조채용동양방법정맥빙주등량0.9%록화납용액。비교3조환자관주전10 min（T1）、관주개시후30 min（T2）、60 min（T3）급관주결속후30 min（T4）혈류동역학지표〔포괄심솔（HR）、평균동맥압（MAP）급혈양포화도（SpO2）〕；비교3조환자 T1、T2、T3、T4급술후24 h（T5）、72 h（ T6）심기매학지표〔포괄혈청기산격매동공매（ CK - MB）화심기기개단백 I （cTnI）수평〕。결과3조환자 T1시 HR 화 MAP 급 T1、T2、T3、T4시 SpO2비교，차이균무통계학의의（P ﹥0.05）；T2、T3、T4시 D1화 D2조환자 HR 저우 C 조、D1조환자 MAP 저우 C 조，T3시 D2조환자 MAP 저우 C 조（P ﹤0.05）。T1、T3급 T6시3조환자혈청 CK - MB 수평비교，차이무통계학의의（P ﹥0.05）；T4、T5시 D1조화 D2조환자혈청CK - MB 수평저우 C 조，D1조환자혈청 CK - MB 수평저우 D2조（P ﹤0.05）。T1、T3시3조환자혈청 cTnI 수평비교，차이무통계학의의（P ﹥0.05）；T4、T5、T6시 D1조화 D2조환자혈청 cTnI 수평저우 C 조，T4、T5시 D1조환자혈청cTnI 수평저우 D2조（P ﹤0.05）。결론우미탁미정대위장도종류환자 ICPH 위술기심기구유보호작용，차고제량우미탁미정적심기보호작용경강。
Objective To investigate the perioperative myocardial protective action of dexmedetomidine in gastrointestinal cancer patients treated by intraoperative peritoneal hyperthermic chemotherapy(IPHC). Methods A total of 48 gastrointestinal cancer patients were selected in Handan Centeral Hospital from May 2014 to May 2015,all of them received gastrointestinal cancer radical operation and IPHC. According to random number table,all of the patients were divided into D1 group,D2 group and C group,each of 16 cases. Before anesthesia induction,patients of D1 group and D2 group received intravenous pumping of dexmedetomidine ( 1 μg/ kg);after anesthesia induction,patients of D1 group received uniform intravenous pumping of dexmedetomidine(0. 5 μg · kg - 1 · h - 1 ),while patients of D2 group received uniform intravenous pumping of dexmedetomidine(0. 2 μg·kg - 1 ·h - 1 ). Patients of C group received same amount of intravenous pumping of 0. 9% sodium chloride injection. Hemodynamic index(including HR,MAP and SpO2 ) before 10 minutes of IPHC,after 30 minutes and 60 minutes of IPHC,after 30 minutes of the end of IPHC was compared among the three groups,respectively;myocardial enzymological index(including serum levels of CK - MB and cTnI) before 10 minutes of IPHC,after 30 minutes, 24 hours and 60 minutes of IPHC,after 30 minutes,24 hours and 72 hours of the end of IPHC was compared among the three groups,respectively. Results No statistically significant differences of HR or MAP was found among the three groups before 10 minutes of IPHC,nor was SpO2 among the three groups before 10 minutes of IPHC,after 30 minutes or 60 minutes of IPHC,or after 30 minutes of the end of IPHC(P ﹥ 0. 05);after 30 minutes,24 hours and 60 minutes of IPHC,after 30 minutes of the end of IPHC,HR of D1 group,D2 group was statistically significantly lower than that of C group,respectively,MAP of D1 groupwas statistically significantly lower than that of C,respectively(P ﹤ 0. 05);MAP of D2 group was statistically significantly lower than that of C group after 60 minutes of IPHC(P ﹤ 0. 05). No statistically significant differences of serum CK - MB level was found among the three groups before 10 minutes of IPHC,after 60 minutes of IPHC or after 72 hours of the end of IPHC(P﹥ 0. 05);after 30 minutes and 24 hours of the end of IPHC,serum CK - MB level of D1 group,D2 group was statistically significantly lower than that of C group,respectively,serum CK - MB level of D1 was statistically significantly lower than that of D2 group(P ﹤ 0. 05). No statistically significant differences of serum cTnI level was found among the three groups before 10 minutes of IPHC or after 60 minutes of IPHC(P ﹥ 0. 05);after 30 minutes,24 hours and 72 hours of the end of IPHC,serum cTnI level of D1 group,D2 group was statistically significantly lower than that of C group,respectively(P ﹤ 0. 05);after 30 minutes and 24 hours of the end of IPHC,serum cTnI level of D1 group was statistically significantly lower than that of D2 group, respectively(P ﹤ 0. 05). Conclusion Dexmedetomidine has some perioperative myocardial protective action in gastrointestinal cancer patients treated by IPHC,and large - dose dexmedetomidine has better perioperative myocardial protective action.