[1]魏 勇,梁 琪,左浩源,等.右美托咪定预处理对冠心病非心脏手术患者心肌的保护作用*[J].陕西医学杂志,2019,(12):1706-1709.
　WEI Yong,LIANG Qi,ZUO Haoyuan,et al.Protective effect of dexmedetomidine preconditioning on myocardium in patients with coronary heart disease undergoing nonheart surgery[J].,2019,(12):1706-1709.
点击复制

右美托咪定预处理对冠心病非心脏手术患者心肌的保护作用*

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2019年12期
页码:
1706-1709
栏目:
药物与临床
出版日期:
2019-12-05

文章信息/Info

Title:
Protective effect of dexmedetomidine preconditioning on myocardium in patients with coronary heart disease undergoing nonheart surgery
文章编号:
DOI:10.3969/j.issn.10007377.2019.12.036
作者:
魏 勇; 梁 琪; 左浩源; 金梅生
西安市中医医院手术麻醉科（西安 710021）
Author(s):
WEI Yong; LIANG Qi; ZUO Haoyuan; et al.
Surgical Anesthesiology Department,Xi’an Traditional Chinese Medicine Hospital（Xi’an 710021）
关键词:
冠心病; 非心脏手术; 美托咪定; 预处理; 心肌保护; 血流动力学
Keywords:
Key words Coronary heart disease; Nonheart surgery; Medetomidine; Preconditioning; Myocardial protection; Hemodynamics
分类号:
R6142
文献标志码:
A
摘要:
摘 要 目的:探讨美托咪定预处理对冠心病（CHD）非心脏手术患者心肌的保护作用。方法:选取择期行非心脏手术的CHD患者90例，按照随机数字法分为对照组（n=45）和观察组（n=45）。对照组在麻醉诱导前15 min给予肌肉注射生理盐水2ml，观察组在麻醉诱导前15min给予肌肉注射右美托咪定2 ml，比较两组血流动力学水平\[舒张压（DPB）、收缩压（SBP）、心率（HR）\]、血清肌酸激酶同工酶（CKMB）、肌钙蛋白Ⅰ（CTnⅠ）、肾上腺素（E）、去甲肾上腺素（NE）水平及并发症发生率。结果:两组T1、T2、T3时DBP、SBP、HR水平均显著低于T0时DBP、SBP、HR水平，T4时DBP、SBP、HR水平均高于T0、T1、T2、T3时DBP、SBP、HR水平（P＜005）观察组T1、T2、T3、T4时HR显著低于对照组（P＜005），但两组DBP、SBP水平比较差异无统计学意义（P＞005）；肌注6 h、12 h后两组血清CKMB水平与术前比较差异无统计学意义（P＞005），血清CTnⅠ、E、NE水平均高于术前（P＜005），且观察组肌注6h、12h后血清CKMB、CTnⅠ、E、NE水平均显著低于对照组（P＜005）；观察组术中心肌缺血、低血压、心动过速发生率均显著高于对照组（P＜005）。结论:右美托咪定预处理能够有效保护CHD非心脏手术患者心肌。
Abstract:
Abstract Objective:To explore protective effect of dexmedetomidine preconditioning on myocardium in patients with coronary heart disease (CHD) undergoing nonheart surgeryMethods:A total of 90 CHD patients undergoing elective nonheart surgery were admitted were enrolled in the studyThey were divided into control group (n=45) and observation group (n=45) by random number table methodThe control group was given intramuscular injection of 2 ml normal saline at 15 min before anesthesia induction,while observation group was given intramuscular injection of 2 ml dexmedetomidineThe levels of haemodynamics\[diastolic blood pressure (DPB),systolic blood pressure (SBP),heart rate (HR)\],serum creatine kinase isoenzyme (CKMB),troponin I (CTnI),adrenaline (E) and norepinephrine (NE),and incidence of complication were compared between the two groupsResults:The levels of DBP,SBP and HR in both groups at T1,T2 and T3 were significantly lower than those at T0 The above indexes at T4 were higher than those at T0,T1,T2 and T3 (P＜005)HR in observation group significantly lower than that in control group at T1,T2 and T3 and T4 (P＜005)There was no significant difference in DBP or SBP level between the two groups (P＞005)At 6 h and 12 h after intramuscular injection,there was no significant difference in serum CKMB of the two groups compared with that before surgery (P＞005)And levels of serum CTnI,E and NE were increased (P＜005)At 6h and 12h after intramuscular injection,levels of serum CKMB,CTnI,E and NE in observation group were significantly lower than those in control group (P＜005)The incidence of myocardial ischemia,hypotension and tachycardia in observation group was significantly higher than that in control group (P＜005)Conclusion:Dexmedetomidine preconditioning can effectively protect myocardium in CHD patients undergoing nonheart surgery

参考文献/References:

[1] 张继如,陈 敏,王志强,等右美托咪定和七氟醚改善冠心病非心脏手术患者围术期心肌缺血的比较[J] .临床麻醉学杂志,2017,33(3):273276
[2] 汪 懿,文怀昌,金孝岠,等右美托咪定对全身麻醉下行非心脏手术老年患者术后早期认知功能影响的Meta分析[J] .临床麻醉学杂志,2017,33(1):4551
[3] 周正清,沈 华,陈轶菁,等电针内关联合右美托咪定对高血糖冠心病患者围术期心肌损伤的保护作用[J] .实用临床医药杂志,2016,20(24):5559
[4] Ergenoglu P,Akin S,Bali C,et al.Effect of low dose dexmedetomidine premedication on propofol consumption in geriatric end stage renal disease patients[J] .Brazilian Journal of Anesthesiology,2015,65(5):326332
[5] 曾凯辉右美托咪定复合七氟醚对冠心病患者非心脏手术后心肌损伤及氧化应激反应的影响[J] .海南医学院学报,2017,23(18):24682471
[6] Rashwan DA,Rashwan SA,Talaat NN,et al.Intravenous dexmedetomidine infusion in adult patients undergoing open nephrolithotomy:Effects on intraoperative hemodynamics and blood loss;a randomized controlled trial[J] .Egyptian Journal of Anaesthesia,2015,31(4):321325
[7] 王 玲,毕燕琳,丛 丽,等七氟醚预处理对老年冠心病患者非心脏手术心肌保护的临床研究[J] .中国现代医学杂志,2013,23(21):9396
[8] Na YK,Kwon TD,Sun JB,et al.Effects of dexmedetomidine in combination with fentanylbased intravenous patientcontrolled analgesia on pain attenuation after open gastrectomy in comparison with conventional thoracic epidural and fentanylbased intravenous patientcontrolled analgesia[J] .International Journal of Medical Sciences,2017,14(10):951960
[9] 任 玲右美托咪定对老年冠心病患者围术期心脏自主神经系统功能的影响[J] .现代中西医结合杂志,2016,25(18):19641966
[10] Lee CW,Kim MEffects of preanesthetic dexmedetomidine on hemodynamic responses to endotracheal intubation in elderly patients undergoing treatment for hypertension:a randomized,doubleblinded trial[J] .Korean Journal of Anesthesiology,2017,70(1):3945
[11] 吕 艳,韩春莹,麻海春,等右美托咪啶在老年冠心病患者行非心脏手术期间心肌保护的研究[J] .中国实验诊断学,2013,17(2):368369
[12] 钱 江,喻刚国,章 琳,等右美托咪定对老年冠心病非心脏手术患者围术期应激反应和学习记忆功能的影响[J] .中国临床药学杂志,2018，41(5):298302
[13] Arulvelan A,Manikandan S,Easwer HV,et al.Effect of loading dose of dexmedetomidine on dynamic cerebral blood flow autoregulation in patients with intracranial glial neoplasms[J] .J Neurosurg Anesthesiol,2015,27(4):289294
[14] 程海涛,王礼伟,陈玲利,等右美托咪定联合生脉注射液对中老年冠心病患者非心脏手术围术期心肌保护效应及对氧化应激、炎性反应的影响[J] .现代中西医结合杂志,2018,27(20):22562259
[15] Kumas M,Altintas O,Karatas E,et al.Protective effect of Ischemic preconditioning on myocardium against remote tissue injury following transient focal cerebral ischemia in diabetic rats[J] .Arquivos Brasileiros De Cardiologia,2017,109(6):516526
[16] 吕 艳,韩春莹,麻海春,等右美托咪啶在老年冠心病患者行非心脏手术期间心肌保护的研究[J] .中国实验诊断学,2013,17(2):368369

相似文献/References:

[1]李艳艳,贾 伟△.24h动态心电图在2型糖尿病合并冠心病患者心律诊断中的价值分析[J].陕西医学杂志,2019,(1):61.
[2]汤克虎,高峻峰,任尽平.药物涂层球囊在糖尿病患者冠状动脉小血管病变治疗中的应用研究*[J].陕西医学杂志,2019,(4):432.
[3]马党捐 ,康彦智 ,柴茂林.64排128层螺旋CT冠状动脉成像在冠心病患者诊断中的价值研究*[J].陕西医学杂志,2019,(5):624.
　MA Dangjuan,KANG Yanzhi,CHAI Maolin..Value analysis of 64rows 128slice spiral CT coronary angiography in the diagnosis of patients with coronary heart disease[J].,2019,(12):624.
[4]沈 琳,马文苑.曲美他嗪联合氯吡格雷治疗冠心病心绞痛疗效及对患者心电图、血清超敏C反应蛋白和五聚素3的影响[J].陕西医学杂志,2019,(6):794.
　SHEN Lin,MA Wenyuan.ElectrocardiogramRoom,Therapeutic Effect ofTrimetazidine Combined with Clopidogrel on Angina Pectoris and its Hs-CRP[J].,2019,(12):794.
[5]杨延洁,周慧龙△.不同双抗血小板疗程对冠心病合并房颤PCI术后患者远期预后的影响*[J].陕西医学杂志,2019,(12):1653.
[6]刘玉珊.心外膜脂肪定量及可溶性血栓调节蛋白与冠心病病变程度相关性分析[J].陕西医学杂志,2020,49(1):44.
　LIU Yushan..Correlation between the distribution of epicardial adipose tissue and soluble thrombomodulin and the severity of coronary heart disease[J].,2020,49(12):44.
[7]赵 博,王银谦,王红燕.巨噬细胞移动抑制因子与冠心病关系Meta分析[J].陕西医学杂志,2020,49(1):125.
[8]王亚平,彭春艳,朱名安Δ.冠心病合并代谢综合征患者固醇调节元件结合蛋白表达水平与脂代谢指标相关性研究*[J].陕西医学杂志,2020,49(4):419.
　WANG Yaping,PENG Chunyan,ZHU Mingan..Correlation between the levels of SREBPs and the indicators of lipid metabolism in patients with coronary heart disease complicated with metabolic syndrome[J].,2020,49(12):419.
[9]南格利.冠心病颈动脉超声参数与斑块稳定性及炎症反应水平相关性分析[J].陕西医学杂志,2020,49(4):453.
　NAN Geli..Correlation between carotid ultrasound parameters and plaque stability and inflammatory response in patients with coronary heart disease[J].,2020,49(12):453.
[10]孙时淼,张 涛△.冠心病患者术前血清超氧化物歧化酶和微小RNA-29b表达及与冠脉CTA钙化积分相关性研究[J].陕西医学杂志,2020,49(7):855.[doi:DOI:10.3969/j.issn.10007377.2020.07.024]
　SUN Shimiao,ZHANG Tao..The expression of superoxide dismutase and microRNA-29b in the serum of patients with coronary heart disease before operation and the correlation between them and CTA calcification score[J].,2020,49(12):855.[doi:DOI:10.3969/j.issn.10007377.2020.07.024]

备注/Memo

备注/Memo:
*陕西省卫生健康委员会科研项目（2018125JL4830）
更新日期/Last Update: 2019-12-19