氢吗啡酮对心脏病患者的心肌保护作用研究
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摘要
目的探讨氢吗啡酮预处理对无需行心脏手术的心脏病患者是否具有心肌保护的作用。方法选择无需行心脏手术的心脏病患者60例,随机分成对照组和实验组。全身麻醉诱导前15 min,对照组肌内注射生理盐水2ml,实验组肌内注射氢吗啡酮2ml。观察两组患者肌内注射即刻(T_0)、插管前(T_1)、插管后(T_2)、肌内注射后1h(T_3)及拔管后(T_4)的血压、心率和心律失常情况。检测手术前和肌内注射后6和24 h的血清磷酸肌酸激酶同工酶、肌钙蛋白I及肌红蛋白的浓度。结果两组患者收缩压(SBP)、舒张压(DBP)比较,差异无统计学意义(P>0.05);实验组心率低于对照组(P<0.05);两组患者T_0、T_1、T_2、T_3时的心律失常发生率比较,差异无统计学意义(P>0.05),实验组T4时心律失常发生率低于对照组(P<0.05);实验组肌内注射后6和24 h的血清磷酸肌酸激酶同工酶、肌红蛋白浓度及肌钙蛋白I异常增高率低于对照组(P<0.05)。结论氢吗啡酮预处理对无需行心脏手术的心脏病患者有心肌保护作用。
Objective To investigate myocardial protection effect of hydromorphone protection effect on noncardiac surgery in patients with heart disease. Methods Totally 60 heart disease patients without cardiac surgery were randomly divided into control group and experimental group. The control group received intramuscular injection of 2 ml of normal saline 15 minutes before induction of general anesthesia, while the experimental group received intramuscular injection of 2 ml of hydromorphone. The blood pressure, heart rate and the change of arrhythmia in two groups were recorded before intramuscular injection(T_0), before intubation(T_1), after intubation(T_2), 1 h after intramuscular injection(T_3) and after extubation(T_4). The concentration of serum creatine kinase isoenzyme, troponin I and myoglobin were detected before the operation, 6 h after intramuscular injection and 24 h after intramuscular injection. Results There was no difference between SBP and DBP(F high pressure=0.074,P = 0.787; F low pressure=1.280, P = 0.262); the heart rate in the experimental group was lower than that in the control group(F = 11.781, P = 0.001); there was no significant difference in the incidence of arrhythmia between the two groups immediately before intramuscular injection(T_0), before intubation(T_1), after intubation(T_2) and 1 h after intramuscular injection(T_3)(P>0.05); the incidence of arrhythmia in the experimental group was lower than that in the control group after extubation(T_4)(P<0.05); the concentration of serum creatine kinase isoenzyme, troponin I and myoglobin in the experimental group were lower than those in the control group 6 h and 24 h after intramuscular injection, and the difference was statistically significant(P<0.05). Conclusions Hydromorphone preconditioning has myocardial protection effect on heart disease patients without cardiac surgery.
Objective To investigate myocardial protection effect of hydromorphone protection effect on noncardiac surgery in patients with heart disease. Methods Totally 60 heart disease patients without cardiac surgery were randomly divided into control group and experimental group. The control group received intramuscular injection of 2 ml of normal saline 15 minutes before induction of general anesthesia, while the experimental group received intramuscular injection of 2 ml of hydromorphone. The blood pressure, heart rate and the change of arrhythmia in two groups were recorded before intramuscular injection(T_0), before intubation(T_1), after intubation(T_2), 1 h after intramuscular injection(T_3) and after extubation(T_4). The concentration of serum creatine kinase isoenzyme, troponin I and myoglobin were detected before the operation, 6 h after intramuscular injection and 24 h after intramuscular injection. Results There was no difference between SBP and DBP(F high pressure=0.074,P = 0.787; F low pressure=1.280, P = 0.262); the heart rate in the experimental group was lower than that in the control group(F = 11.781, P = 0.001); there was no significant difference in the incidence of arrhythmia between the two groups immediately before intramuscular injection(T_0), before intubation(T_1), after intubation(T_2) and 1 h after intramuscular injection(T_3)(P>0.05); the incidence of arrhythmia in the experimental group was lower than that in the control group after extubation(T_4)(P<0.05); the concentration of serum creatine kinase isoenzyme, troponin I and myoglobin in the experimental group were lower than those in the control group 6 h and 24 h after intramuscular injection, and the difference was statistically significant(P<0.05). Conclusions Hydromorphone preconditioning has myocardial protection effect on heart disease patients without cardiac surgery.
引文
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[7]陈齐,张英,刘庆,等.氢吗啡酮后处理对大鼠心肌缺血再灌注损伤的影响及线粒体通透性转换孔在其中的作用[J].中华麻醉学杂志, 2015, 35(10):1197-1201.
[8]周新,涂植光.临床生物化学和生物化学检验[M].北京:人民卫生出版社, 2006:284-294.
[9]高珊,李伟彦.手术应激反应的监测与调控[J].医学综述, 2014,20(11):2011-2013.
[10]张扬,丁楠楠,徐阳,等.氢吗啡酮超前镇痛对妇科腔镜手术应激反应的影响[J]. Herld of Medicine, 2017, 36(4):417-419.
[11]陈杰华,马海燕.盐酸氢吗啡酮应用于腹腔镜胆囊切除术老年患者对气管插管应激反应和围术期细胞因子的影响[J].陕西医学杂志, 2017, 46(7):955-957.
[2]CHEN Z, SPAHN D R. Morphine postconditioning protects against reperfusion injury:the role of protein kinase c-epsilon, extracellular signal-regulated kinase 1/2 and mitochondrial permeability transition pores cell[J]. Physiol Biochem, 2016, 39(5):1930-1940.
[3]ZHANG N, CHEN K, RHA S W. Morphine in the setting of acute myocardial infarction:pros and cons[J]. Am J Emerg Med, 2016,34(4):746-748.
[4]CHEN Z, LI T, ZHANG B. Morphine postconditioning protects against reperfusion injury in the isolated rat hearts[J]. J Surg Res,2008, 145(2):287-294.
[5]BELLANDI B, ZOCCHI C, XANTHOPOULOU I, et al. Morphine use and myocardial reperfusion in patients with acute myocardial infarction treated with primary PCI[J]. Int J Cardiol, 2016,221(25):567-571.
[6]陈作雷,周廷发,刘中凯.吗啡后处理对大鼠离体心脏缺血再灌注损伤的影响[J].中华麻醉学杂志, 2009, 29(2):111-114.
[7]陈齐,张英,刘庆,等.氢吗啡酮后处理对大鼠心肌缺血再灌注损伤的影响及线粒体通透性转换孔在其中的作用[J].中华麻醉学杂志, 2015, 35(10):1197-1201.
[8]周新,涂植光.临床生物化学和生物化学检验[M].北京:人民卫生出版社, 2006:284-294.
[9]高珊,李伟彦.手术应激反应的监测与调控[J].医学综述, 2014,20(11):2011-2013.
[10]张扬,丁楠楠,徐阳,等.氢吗啡酮超前镇痛对妇科腔镜手术应激反应的影响[J]. Herld of Medicine, 2017, 36(4):417-419.
[11]陈杰华,马海燕.盐酸氢吗啡酮应用于腹腔镜胆囊切除术老年患者对气管插管应激反应和围术期细胞因子的影响[J].陕西医学杂志, 2017, 46(7):955-957.