右美托咪啶对非体外循环冠脉搭桥术患者围术期炎性因子及心肌损伤的影响

Effect of dexmedetomidine on perioperative inflammatory factors and myocardial injury in patients with off-pump coronary artery bypass grafting

目的在非体外循环冠状动脉旁路移植手术(OPCABG)围术期给予右美托咪啶,检测血液炎性因子的变化,并探讨对患者心肌的保护作用。方法选择2015年5月–2017年4月在本院进行OPCABG的冠心病患者78例,随机分为对照组和观察组,两组各39例。对照组患者输注等容量0.9%氯化钠注射液,观察组患者给予盐酸右美托咪啶。分别于麻醉诱导后(T0)、手术前(T1)、术后2 h(T_2)、术后24 h(T_3)检测患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8),肌钙蛋白I(c Tn I)和肌酸激酶同工酶MB(CK-MB)浓度。结果观察组患者T_2和T_3时血液TNF-α、IL-8、c Tn I和CK-MB分别为(15.27±3.13)和(20.32±3.46)μg/L、(14.28±2.76)和(18.28±0.76)ng/ml、(2.21±0.58)和(3.17±0.87)ng/ml、(11.06±3.22)和(25.26±4.31)ng/ml,均低于对照组,差异有统计学意义(P<0.05)。结论在OPCABG围术期应用右美托咪啶,可显著降低炎性因子水平,下调c Tn I和心肌酶水平,对患者心肌具有显著的保护作用。

Objective Patients with the off-pump coronary artery bypass grafting surgery（OPCABG） were administered with dexmedetomidine during the perioperative period, and the protective effect of the drug on inflammatory cytokines and myocardium were detected. Methods Seventy-eight patients with coronary heart disease treated with OPCABG were enrolled in our hospital from May in 2015 to April in 2017. They were randomly divided into control group and observation group, with 39 cases in each group. Sodium chloride（0.9%） injection was given in the control group, while dexmedetomidine hydrochloride was given in the observation group. The levels of serum tumor necrosis factor-α（TNF-α）, interleukin-8（IL-8）, troponin I（cTnI） and creatine kinase isoenzyme MB（CK-MB） were measured after anesthesia induction（T0）, 1 h before operation（T1）, 2 h post operation（T2） and 24 h post operation（T3）. Results The levels of TNF-α, IL-8, c Tn I and CK-MB at T2 and T3 in the observation group were（15.27 ± 3.13） and（20.32 ± 3.46） μg/L,（14.28 ± 2.76） and（18.28 ± 0.76） ng/ml,（2.21 ± 0.58） and（3.17 ± 0.87） ng/ml,（11.06 ± 3.22） and（25.26 ± 4.31） ng/ml, respectively, which were lower than those in the control group, respectively. The difference was statistically significant（P〈 0.05）. Conclusion Application of dexmedetomidine during perioperative OPCABG can significantly reduce the level of inflammatory factors, as well as c Tn I and myocardial enzyme levels. The drug has significant protective effect on the myocardium.