右美托咪定与咪达唑仑镇静对经皮冠状动脉介入治疗患者心肌保护效应的比较

Comparison of dexmedetomidine versus midazolam sedation for myocardial protection in patients undergoing percutaneous coronary intervention

目的 比较右美托咪定与咪达唑仑镇静对经皮冠状动脉介入治疗（PCI）患者的心肌保护效应.方法 选择急性心肌梗死需行急诊PCI患者60例,性别不限,ASA分级Ⅲ或Ⅳ级,年龄41-88岁,体重45 - 85 kg,采用随机数字表法,将患者分为2组（n=30）：右美托咪定组（D组）和咪达唑仑组（M组）.D组于术前静脉输注右美托咪定负荷剂量1 μg/kg,输注时间10 min,M组术前静脉注射咪达唑仑0.05 mg/kg,两组术中分别静脉泵注右美托咪定0.2- 1.4 μg·kg-1·h-1和咪达唑仑0.02 - 0.10mg· kg-1 ·h-1至手术结束,根据RASS镇静程度评估表,维持RASS-2-2.于给药前及术后第3天行心脏彩色多普勒超声,记录左心室射血分数（LVEF）,采集肘静脉血,测定血清心肌酶和心肌肌钙蛋白Ⅰ（cTnI）水平,记录手术并发症发生情况、ICU停留时间及住院时间.结果 与M组比较,D组术后第3天血清肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、谷草转氨酶（AST）及乳酸脱氢酶（LDH）的活性和cTnI浓度降低,LVEF升高,ICU停留时间及住院时间缩短（P＜0.05）;两组术后并发症发生情况差异无统计学意义（P＞0.05）.结论 与咪达唑仑比较,右美托咪定镇静对PCI患者心肌保护效应及预后效果更佳,更适合PCI患者的镇静.

Objective To compare dexmedetomidine versus midazolam sedation for myocardial protection in the patients undergoing percutaneous coronary intervention （PCI）.Methods Sixty patients with acute myocardial infarction who required for emergency PCI,were selected and randomly divided into 2 groups （n =30 each） using a random number table：dexmedetomidine group （group D） and midazolam group （group M）.In group D,a loading dose of dexmedetomidine 1 μg/kg was infused intravenously for 10 min before surgery.In group M,midazolam 0.05 mg/kg was injected intravenously before surgery.Dexmedetomidine 0.2-1.4 μg· kg-1 · h-1 and midazolam 0.02-0.10 mg·kg-1 ·h-1 were given via a pump during surgery until the end of surgery in the two groups.The RASS score was maintained at-2-2 in two groups.Before administration and on 3rd day after surgery,cardiovascular color doppler ultrasound was performed to record left ventricular ejection fraction （LVEF）,venous blood samples were collected for determination of the levels of serum myocardial enzyme and cardiac troponin I （cTnI）,and the development of surgical complications,duration of ICU stay and length of hospital stay were recorded.Results Compared with group M,the activities of serum creatine kinase,creatine kinase isoenzyme-MB,aspartate amino transferase and lactic dehydrogenase and cTnI concentrations were significantly decreased,LVEF was increased,and duration of ICU stay and length of hospital stay were shortened in group D.There was no significant difference in the development of postoperative complications between the two groups.Conclusion Dexmedetomidine sedation provides better efficacy for myocardial protection and prognosis and is more suitable for sedation than midazolam in the patients undergoing PCI.