右美托咪定对老年冠心病患者围手术期心脏不良事件的影响

Effects of dexmedetomidine on perioperative cardiac adverse events in elderly patients with coronary heart disease

目的:观察右美托咪定对冠心病患者围手术期心脏不良事件的影响。方法:择期行开腹胃癌切除术的老年冠心病患者60例,采用随机数字表法将其分为右美托咪定组(Dex组)与对照组(Control组),每组30例。两组患者麻醉管理一致,其中Dex组诱导麻醉前10 min静脉微量泵入右美托咪定0.5μg/kg,10 min后继续泵注维持量0.5μg/(kg·h)至手术结束;Control组在同一时点采用等量的生理盐水静脉输注。分别于术前、术毕、术后24 h采集静脉血标本,测定肌钙蛋白I(c Tn I)、N-末端脑利钠肽原(N-terminal pro-brain natriuretic peptide,NT-pro BNP)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)的水平。记录术中、术后3 d心脏不良事件的发生情况。结果:两组患者术前血清c Tn I,NTpro BNP,hs-CRP水平比较,差异无统计学意义(P>0.05);术后24 h时血清c Tn I,NT-pro BNP,hs-CRP较术前都显著升高(P<0.05),且Dex组在术后24 h时血清c Tn I,NT-pro BNP及hs-CRP水平明显低于Control组(P<0.05)。两组患者术中均未发生心肌梗死;与Control组比较,Dex组心动过缓发生率升高,心动过速和心肌缺血发生率降低(P<0.05)。Dex组术后无症状性心肌缺血和心律失常发生率与Control组相比明显降低(P<0.05)。结论:右美托咪定能够降低老年冠心病患者围手术期心脏不良事件的发生率。

Objective： To investigate the effects of dexmedetomidine on perioperative cardiac adverse events in elderly patients with coronary heart disease.Methods： Sixty elderly patients, who were diagnosed as coronary heart disease and underwent gastric cancer operation, were randomly divided into 2 groups （n=30）： the dexmedetomidine group （Dex group） and the control group. In the Dex group, dexmedetomidine was administered intravenously at 0.5 μg/（kg.h） after a bolus infusion at 0.5 μg/kg for 10 min before anesthesia induction. In the control group, equal volume of normal saline was infused instead of dexmedetomidine. The 2 groups received the same anesthesia treatment. The venous bloods were collected at the preoperative 0 h and postoperative 24 h. The concentrations of cardiac troponin （cTnI）, N-terminal pro-brain natriuretic peptide （NT-proBNP） and hypersensitive C-reactive protein （hs-CRP） were determined. The ECG was monitored at the above time and the postoperative incidence of cardiac adverse events was recorded. Results： qqae levels of cTnI, NT-proBNP and hs-CRP in serum were elevated in the 2 groups after the operation. Compared with the control group, the levels of cTnI, NT-proBNP and hs-CRP were significantly decreased in the Dex group （P〈0.05）. Compared with the control group, the incidence of bradycardia were significantly increased, while the myocardial ischemia and tachycardia were significantly decreased in the Dex group during the operation （P〈0.05）; the incidence of silent myocardial ischemia and arrhythmia was significantly reduced at 3 days after operation in the Dex group （P〈0.05）. Conclusion： Dexmedetomidine could decrease the incidence of cardiac adverse events in elderly patients with coronary heart disease.