右美托咪定对急性冠状动脉综合征患者行急诊经皮冠状动脉介入治疗的心肌保护作用

Cardioprotective effect of dexmedetomidine in patients with acute coronary syndrome during emergency percutaneous coronary intervention

目的观察右美托咪定对急性冠状动脉综合征（acute coronary syndrome,ACS）患者行急诊经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗中血流动力学及心肌损伤标记物的影响,评价应用右美托咪定的心肌保护作用。方法收集2013年9月至2014年9月就诊于华润武钢总医院急诊科行PCI治疗的ACS患者60例,按随机数字表法随机分成对照组30例和右美托咪定组30例。对照组接受常规PCI治疗,右美托咪定组于PCI治疗开始前10 min予负荷剂量右美托咪定（0.5μg/kg）,再于微泵静脉注射右美托咪定0.3μg/（kg·h）维持至术后12 h。记录所有患者给药前（T0）及给药后10 min（T1）、30 min（T2）、1 h（T3）、2 h（T4）、3 h（T5）、12 h（T6）的基础心率、呼吸频率、平均动脉压。记录T1~T6Ramsay评分。分别于术前及术后8 h、24 h测定血清心肌肌钙蛋白和血清肌酸激酶同工酶浓度,测定术前及术后24 h血清N末端脑钠肽前体浓度。结果两组在T0时点心率、呼吸频率、平均动脉压比较,差异无统计学意义（P〉0.05）。与T0相比,右美托咪定组在T1~T6时点平均动脉压、心率显著降低,差异有统计学意义（P〈0.05）;对照组T1~T6时点平均动脉压、心率与T0比较显著升高,差异有统计学意义（P〈0.05）。在T1~T6各时点,右美托咪定组的平均动脉压、心率显著低于对照组,差异有统计学意义（P〈0.05）,而呼吸频率差异无统计学意义（P〉0.05）。T2~T6时点右美托咪定组Ramsay评分显著高于对照组,差异有统计学意义（P〈0.05）。对照组和右美托咪定组PCI治疗前血清心肌肌钙蛋白I、肌酸激酶同工酶及N末端脑钠肽前体浓度比较,差异无统计学意义（P〉0.05）;术后8 h右美托咪定组血清心肌肌钙蛋白I、肌酸激酶同工酶峰浓度明显低于对照组,差异有统计学意义（P〈0.05）;术后24 h右美托咪定组血清N末端脑钠肽前体浓度明显低于对照组,差异有统计学意义（P〈0.05）。结论 PCI治疗中静脉应用右美托咪定,对ACS患者有镇静、镇痛作用,可以缓解患者的焦虑,稳定血流动力学,可减轻心肌的进一步损伤,产生一定心肌保护作用。

Objectives To observe the effect of dexmedetomidine in patients with acute coronary syndrome（ACS）during emergency percutaneous coronary intervention（PCI）. Methods Sixty patients with ACS undergoing PCI in The Wugang General Hospital from September 2013 to September 2014 were randomly divided into two groups ： control group（n =30） and dexmedetomidine group（n =30）. Both of the two groups received PCI treatment. Dexmedetomidine group was additionally given a loading dose of dexmedetomidine [0.5 μg /（kg·h） ] for 10 min followed by infusion[0.3 μg /（kg·h） ] until 12 hours after PCI. Mean artery pressure（MAP）, heart rate（HR） and respiratory rate（RR）were recorded before administration（T0） and 10 min（T1）, 30 min（T2）, 1 h（T3）, 2 h（T4）, 3 h（T5）, 12 h（T6）after administration. Concentrations of creatine kinase MB（CK-MB） and troponin I（TNI） were measured before PCI and 8 h, 24 h after PCI. Concentration of N-terminal pro-brain natriuretic peptide（NT-pro BNP） was measured before PCI and 24 h after PCI. Results There was no significant difference between the two groups at T0 in MAP, HR and RR（P〈0.05）.MAP and HR of dexmedetomidine group significantly decreased at T1-T6 compring to T0（P〈0.05）, and MAP and HR of control group significantly increased at T1-T6 compring to T0（P〉0.05）. Compared with those in control group, MAP and HR significantly decreased at T1-T6 in dexmedetomidine group（P〈0.05）, while RR had no significant difference between the two groups（P〉0.05）. Concentrations of NT-pro BNP, CK-MB and TNI of the two groups before PCI were not different（P〈0.05）. Concentration of NT-pro BNP of the two groups after PCI obviously decreased（P〈0.05）, and it decreased more significantly in dexmedetomidine group 24 h after PCI（P〈0.05）.Concentrations of CK-MB and TNI 8 h after PCI in control group increased more obviously than those in dexmedetomidine group（P0.05）. Conclusions Dexmedetomidine can alleviate the patient＇s anxiety and has a cardioprotective effect.