右美托咪定在颅内动脉支架植入术中的应用及对患者血清心肌酶、肌钙蛋白Ⅰ与左心室射血分数的影响

Application of dexmedetomidine in intracranial arterial stenting and its influence on the serum myocardial enzyme,cTnI and LVEF

目的分析右美托咪定在颅内动脉支架植入术中的应用效果及对患者血清心肌酶、心肌肌钙蛋白I(cTnI)与左心室射血分数(LVEF)的影响。方法选择2015年3月至2017年3月于丽水市人民医院行颅内动脉支架植入患者94例,采用随机数字表法分作对照组与观察组各47例,对照组采用常规麻醉,观察组采用右美托咪定,比较两组酶磷酸肌酸激酶同工酶(CK-MB)、磷酸肌酸激酶(CK)、cTnI、LVEF、炎性因子、神经功能、脑氧代谢和并发症。结果术后,观察组CK-MB、CK、cTnI低于对照组[(35.27±4.41)U/L、(488.30±61.03)U/L、(3.85±0.49)μg/L比(46.40±5.79)U/L、(611.21±76.40)U/L、(4.72±0.59)μg/L],观察组LVEF高于对照组[(45.60±5.72)%比(43.12±5.39)%],差异均有统计学意义(t=10.484、8.619、7.777、2.163,均P<0.05)。观察组白细胞介素6(IL-6)、白细胞介素-8(IL-8)、肿瘤细胞坏死因子-α(TNF-α)、S-100β、特异性烯醇化酶(NSE)、脑氧代谢率(ERO2)、动脉血氧饱和度(PaO2)、颈静脉血氧饱和度(SjvO2)均低于对照组(t=5.794、6.177、15.065、6.964、5.606、3.147、2.116、2.807,均P<0.05)。观察组并发症发生率低于对照组(χ2=17.091,P<0.05)。结论右美托咪定可对颅内动脉支架植入患者的心肌起到保护作用,抑制血清心肌酶、cTnI上升,利于LVEF的恢复。

Objective To analyze the application of dexmedetomidine in intracranial arterial stenting and its influence on the serum myocardial enzyme,cardiac troponin I(cTnI) and left ventricular ejection fraction(LVEF).Methods From March 2015 to March 2017,94 cases with intracranial arterial stenting in the People's Hospital of Lishui were divided into control group and observation group by the random number table method,with 47 cases in each group.The control group was treated with conventional anesthesia,the observation group was treated with dexmedetomidine.The enzyme creatine phosphate kinase isoenzyme(CK-MB),creatine phosphate kinase(CK),cTnI,LVEF,inflammatory factor,neural function,brain oxygen metabolism and complications in the two groups were compared.ResultsAfter surgery,the CK-MB,CK,cTnI levels of the observation group were lower than those of the control group[(35.27±4.41)U/L,(488.30±61.03)U/L,(3.85±0.49)μg/L vs.(46.40±5.79)U/L,(611.21±76.40)U/L,(4.72±0.59)μg/L],the LVEF of the observation group was higher than that of the control group[(45.60±5.72)% vs.(43.12±5.39)%],the differences were statistically significant(t=10.484,8.619,7.777,2.163,all P<0.05). The interleukin-6(IL-6) and interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),S-100β,specificity enolization enzyme(NSE),cerebral metabolic rate of oxygen(ERO2),arterial blood oxygen saturation(PaO2),carotid venous blood oxygen saturation(SjvO2) of the observation group were better than those of the control group(t=5.794,6.177,15.065,6.964,5.606,3.147,2.116,2.807,all P<0.05). The incidence rate of complication of the observation group was lower than that of the control group(χ^2=17.091,P<0.05).Conclusion Application of dexmedetomidine in intracranial arterial stenting can protect myocardium,inhibit the serum levels of myocardial enzyme,cTnI rise,and is conducive to the recovery of LVEF.