右旋美托咪啶对老年胸科手术患者围术期心肌酶及心肌肌钙蛋白T的影响

Effects of Dexmedetomidine on perioperative myocardial enzymes and troponin T of the myocardium in elderly patients undergoing thoracic surgery

目的:观察右旋美托咪啶对老年胸科手术患者围术期心肌酶及心肌肌钙蛋白T(cTnT)的影响。方法:40例患者随机分成右旋美托咪啶组(D组)和对照组(A组)。于麻醉前、术毕、术后6、24、48h采血检查血清肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、天冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)及肌钙蛋白T(cTnT)的浓度。结果:(1)两组镇痛效果差异无显著性。(2)A组CK,AST,LDH在术毕及术后均明显高于麻醉前(P<0.05),cTnT在术后均显著高于麻醉前(P<0.01)。(3)D组各指标变化与麻醉前差异均无显著性(P>0.05);D组的CK、AST在术毕及术后6h显著低于A组(P<0.05),LDH在术后6h显著低于A组(P<0.05),而cTnT在术后6、24及48h均显著低于A组(P<0.05)。结论:右旋美托咪啶用于老年开胸手术患者能有效降低应激反应,减少患者围术期心肌的受损。

Objective:To observe the effects of Dexmedetomidine perioperative myocardial enzymes and troponin T(cTnT)of the myocardium in elderly patients undergoing thoracic surgery.Methods:Forty elderly patients were randomly divided into two groups:control group(Group A),Dexmedetomidine group(Group D).Peripheral blood creatine kinase(CK),CK-MB,aspartate aminotransferase(AST),lactate dehydrogenase(LDH)and cTnT were measured before anesthesia,at end of operation and at 6,24,48 hours after operation.Results:(1)There was no significantly difference in analgesia effect between two groups.(2)In groupA,serum CK,AST,and LDH concentration at end of operation and after operation were higher than those before anesthesia(P<0.05),and cTnT after operation were higher than those before anesthesia(P < 0.01).(3)In group D,all detection indexes before anesthesia had no significantly deferences with those at other testing times(P<0.05).At 6 hours after operation,serum LDH concentration in group D were significantly lower than those in group A(P<0.05).At 6,24,48 hours after operation,serum cTnT concentration in group D were significantly lower than those in group A(P<0.05).Conclusion:Dexmedetomidine is good for elderly patients undergoing thoracic surgery,because the stress reaction can be markedly attenuated and it has a protective effect on myocardial injury induced by operation.