右美托咪定对体外循环术后患者的心脏保护作用的研究
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摘要
目的探讨右美托咪定对ICU中体外循环心脏术后患者的心肌保护作用。方法收集我院2014年9月～2018年8月ICU收治的体外循环心脏术后患者107例,随机分为实验组(54例)及对照组(53例)。对照组患者使用咪达唑仑或丙泊酚镇静,实验组患者给予右美托咪定镇静。记录两组患者手术时间、体外循环时间及术后ICU停留时间等手术相关资料;比较两组术后1、24、48 h血压、心率(HR)、肌钙蛋白Ⅰ(cTnⅠ)、心肌肌酸激酶同工酶(CK-MB)、脑钠肽(NT-BNP)、中心静脉压(CVP)及左心射血分数(EF)。结果实验组患者术后ICU停留时间短于对照组,差异有统计学意义(P<0.05);术后24、48 h实验组cTnⅠ、CK-MB水平低于对照组,差异有统计学意义(P<0.05);离开ICU时实验组MAP为(77.82±1.87)mmHg,对照组MAP为(82.64±1.69)mmHg,差异有统计学意义(P<0.05);实验组术后心律失常发生率低于对照组,差异有统计学意义(P<0.05)。结论①心脏手术后使用右美托咪定通过心肌保护作用,可以一定程度上改善预后;②本研究不支持右美托咪定致窦性心动过缓发生率增加,同时右美托咪定可以减少心律失常发生率;③体外循环心脏手术患者应用右美托咪定镇静,需警惕临床中低血压风险。
Objective To investigate the myocardial protective effect of dexmedetomidine on patients with cardiopulmonary bypass after ICU.Methods A total of 107 patients with cardiopulmonary bypass who underwent ICU admitted to our hospital from September 2014 to August 2018 were randomly divided into experimental group(54 cases) and control group(53 cases). Patients in the control group were sedated with midazolam or propofol, and patients in the experimental group were given dexmedetomidine sedation. Surgical data such as operation time, cardiopulmonary bypass time and postoperative ICU stay time were recorded. The blood pressure, heart rate(HR), troponin I(cTnI) and cardiac creatine were compared at 1,24 and 48 h after operation. Kinase isoenzyme(CK-MB), brain natriuretic peptide(NT-BNP), central venous pressure(CVP), and left ventricular ejection fraction(EF).Results The ICU stay in the experimental group was shorter than that in the control group,the difference was statistically significant(P<0.05). The levels of c TnI and CK-MB in the experimental group were lower than those in the control group at 24 and 48 hours after operation,the difference was statistically significant(P<0.05). The MAP of the experimental group was(77.82±1.87) mmHg when leaving the ICU, and the MAP of the control group was(82.64±1.69) mmHg,the difference was statistically significant(P<0.05). The incidence of posterior arrhythmia was lower than that of the control group,the difference was statistically significant(P <0.05).Conclusion ① The use of dexmedetomidine after cardiac surgery can improve the prognosis to some extent through myocardial protection; ②This study does not support the increase in the incidence of sinus bradycardia caused by dexmedetomidine, while dexmedetomidine can Reduce the incidence of arrhythmia; ③ Patients with cardiopulmonary bypass surgery with dexmedetomidine sedation, need to be alert to the risk of clinical hypotension.
Objective To investigate the myocardial protective effect of dexmedetomidine on patients with cardiopulmonary bypass after ICU.Methods A total of 107 patients with cardiopulmonary bypass who underwent ICU admitted to our hospital from September 2014 to August 2018 were randomly divided into experimental group(54 cases) and control group(53 cases). Patients in the control group were sedated with midazolam or propofol, and patients in the experimental group were given dexmedetomidine sedation. Surgical data such as operation time, cardiopulmonary bypass time and postoperative ICU stay time were recorded. The blood pressure, heart rate(HR), troponin I(cTnI) and cardiac creatine were compared at 1,24 and 48 h after operation. Kinase isoenzyme(CK-MB), brain natriuretic peptide(NT-BNP), central venous pressure(CVP), and left ventricular ejection fraction(EF).Results The ICU stay in the experimental group was shorter than that in the control group,the difference was statistically significant(P<0.05). The levels of c TnI and CK-MB in the experimental group were lower than those in the control group at 24 and 48 hours after operation,the difference was statistically significant(P<0.05). The MAP of the experimental group was(77.82±1.87) mmHg when leaving the ICU, and the MAP of the control group was(82.64±1.69) mmHg,the difference was statistically significant(P<0.05). The incidence of posterior arrhythmia was lower than that of the control group,the difference was statistically significant(P <0.05).Conclusion ① The use of dexmedetomidine after cardiac surgery can improve the prognosis to some extent through myocardial protection; ②This study does not support the increase in the incidence of sinus bradycardia caused by dexmedetomidine, while dexmedetomidine can Reduce the incidence of arrhythmia; ③ Patients with cardiopulmonary bypass surgery with dexmedetomidine sedation, need to be alert to the risk of clinical hypotension.
引文
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[3]Chuich T,Cropsey CL,Shi Y,et al.Perioperative Sedation in Mechanically Ventilated Cardiac Surgery Patients With Dexmedetomidine-Based Versus Propofol-Based Regimens[J].Ann Pharmacother,2019,53(1):5-12.
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[6]Gong Z,Li J,Zhong Y,et al.Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting[J].Exp Ther Med,2018,16(6):4685-4689.
[7]van Geene Y,van Swieten HA,Noyez L.Cardiac troponin I levels after cardiac surgery as predictor for in-hospital mortality[J].Interact Cardiovasc Thorac Surg,2010,10(3):413-416.
[8]Tempe DK,Dutta D,Garg M,et al.Myocardial protection with isoflurane during off-pump coronary artery bypass grafting:a randomized trial[J].J Cardiothorac Vasc Anesth,2011,25(1):59-65.
[9]Sheikh TA,Dar BA,Akhter N,et al.A Comparative Study Evaluating Effects of Intravenous Sedation by Dexmedetomidine and Propofol on Patient Hemodynamics and Postoperative Outcomes in Cardiac Surgery[J].Anesth Essays Res,2018,12(2):555-560.
[10]Chi X,Liao M,Chen X,et al.Dexmedetomidine Attenuates Myocardial Injury in Off-Pump Coronary Artery Bypass Graft Surgery[J].J Cardiothorac Vasc Anesth,2016,30(1):44-50.
[11]Berendes E,Schmidt C,Van Aken H,et al.A-type and Btype natriuretic peptides in cardiac surgical procedures[J].Anesth Analg,2004,98(1):11-19.
[12]Ling X,Zhou H,Ni Y,et al.Does dexmedetomidine have an antiarrhythmic effect on cardiac patients? A meta-analysis of randomized controlled trials[J].PLoS One,2018,13(3):e0193303.
[2]Bal L,Thierry S,Brocas E,et al.B-type natriuretic peptide(BNP)and N-terminal-proBNP for heart failure diagnosis in shock or acute respiratory distress[J].Acta Anaesthesiol Scand,2006,50(3):340-347.
[3]Chuich T,Cropsey CL,Shi Y,et al.Perioperative Sedation in Mechanically Ventilated Cardiac Surgery Patients With Dexmedetomidine-Based Versus Propofol-Based Regimens[J].Ann Pharmacother,2019,53(1):5-12.
[4]Willigers HM,Prinzen FW,Roekaerts PM,et al.Dexmedetomidine decreases perioperative myocardial lactate release in dogs[J].Anesth Analg,2003,96(3):657-664.
[5]Peng K,Ji FH,Liu HY,et al.Effects of Perioperative Dexmedetomidine on Postoperative Mortality and Morbidity:A Systematic Review and Meta-analysis[J].Clin Ther, 2019,41(1):138-154.
[6]Gong Z,Li J,Zhong Y,et al.Effects of dexmedetomidine on postoperative cognitive function in patients undergoing coronary artery bypass grafting[J].Exp Ther Med,2018,16(6):4685-4689.
[7]van Geene Y,van Swieten HA,Noyez L.Cardiac troponin I levels after cardiac surgery as predictor for in-hospital mortality[J].Interact Cardiovasc Thorac Surg,2010,10(3):413-416.
[8]Tempe DK,Dutta D,Garg M,et al.Myocardial protection with isoflurane during off-pump coronary artery bypass grafting:a randomized trial[J].J Cardiothorac Vasc Anesth,2011,25(1):59-65.
[9]Sheikh TA,Dar BA,Akhter N,et al.A Comparative Study Evaluating Effects of Intravenous Sedation by Dexmedetomidine and Propofol on Patient Hemodynamics and Postoperative Outcomes in Cardiac Surgery[J].Anesth Essays Res,2018,12(2):555-560.
[10]Chi X,Liao M,Chen X,et al.Dexmedetomidine Attenuates Myocardial Injury in Off-Pump Coronary Artery Bypass Graft Surgery[J].J Cardiothorac Vasc Anesth,2016,30(1):44-50.
[11]Berendes E,Schmidt C,Van Aken H,et al.A-type and Btype natriuretic peptides in cardiac surgical procedures[J].Anesth Analg,2004,98(1):11-19.
[12]Ling X,Zhou H,Ni Y,et al.Does dexmedetomidine have an antiarrhythmic effect on cardiac patients? A meta-analysis of randomized controlled trials[J].PLoS One,2018,13(3):e0193303.