地尔硫[艹卓]对老年高血压病患者全髋关节置换术围术期心肌的保护作用

The protective effect of diltiazem on perioperative myocardial injury in elderly hypertension patients

目的 观察地尔硫[艹卓]对老年高血压病患者全髋关节置换术围术期心肌的保护作用.方法 择期行全髋关节置换手术的老年高血压病患者30例,完全随机分为地尔硫[艹卓]组和对照组,每组15例.地尔硫[艹卓]组在麻醉诱导前5 min静脉注射地尔硫[艹卓]0.15 mg/kg,然后以15 mg/h静脉输注维持.分别在麻醉诱导前10 min、气管插管后即刻、拔除气管导管后即刻,记录心电图ST段水平.于麻醉前、手术开始后1h、术毕、术后12 h、术后24h抽取中心静脉血,采用白蛋白钴结合试验测定缺血修饰白蛋白.结果 气管插管后、拔 除气管导管后即刻ST段出现心肌缺血性改变者,对照组（6例）明显多于地尔硫[艹卓]组（1例）（P＜0.05）,地尔硫[艹卓]组手术开始后1h和术毕明显低于对照组[（63.4±12.2） IU/L比（79.3±9.4） IU/L,（64.3±12.0） IU/L比（78.3±8.5）IU/L,P＜0.05].结论 麻醉诱导前静脉注射0.15 mg/kg地尔硫[艹卓]及术中持续维持,能减轻老年高血压病患者全髋关节置换术围术期心肌损伤,对心肌有一定保护作用.

Objective To investigate the changes of expression of ischemia modified albumin （IMA） in elderly hypertension patients undergoing hip replacement surgery.Methods Thirty patients with hypertension were randomly divided into diltiazem group and control group,with 15 cases in each group.In diltiazem group,0.15 mg/kg diltiazem was given intravenously before anesthesia induction and maintained with a rate of 15 mg/h during operation.The changes in ST segment were recorded 10 minutes before anesthesia,after intubation at once and immediately after extubation.The central venous blood samples were obtained to measure the expression of IMA before anesthesia （ To ）,1 h after skin incision （ T1 ）,at the end of operation （ T2 ） and 12 h（ T3 ）,24 h（ T4 ） after operation using albumin cobalt binding （ACB） test.Results The cases of ST segment showing myocardial injury had significant differences between diltiazem group and control group （6 cases vs 1 case） （P 〈 0.05 ）.The expression of IMA in diltiazem group at T1 and T2 were obviously lower than that in control group[ （63.4 ± 12.2） IU/L vs （79.3 ± 9.4）IU/L,（64.3±12.0）IU/Lvs （78.3±8.5）IU/L,P〈0.05].Conclusion Intravenous0.15 mg/kg of diltiazem can attenuate the degree of myocardial damage in elderly hypertension patients undergoing hip replacement surgery.