右美托咪定在合并肺源性心脏病患者腹部手术围术期的心肌保护作用研究

Myocardial protective effect of Dexmedetomidine in the perioperative period of abdominal operation in patients with pulmonary heart disease

目的 研究右美托咪定在合并肺源性心脏病患者腹部手术围术期的心肌保护作用。方法 选择2016年6月至2017年6月在江汉大学附属医院[]诊断为肺心病且需要接受腹部手术的患者126例，随机分为试验组和对照组各63例。试验组在麻醉的基础上术中加用右美托咪定静脉泵入，对照组给予等量的生理盐水。对比两组患者手术前、手术后0、6、12、24 h的心肌损伤标志物，包括缺血修饰白蛋白（IMA）和肌钙蛋白（cTnI），以及入手术室（t0）、麻醉诱导时（t1）、手术开始即刻（t2）、手术结束时（t3）的心率变异性。结果[结果部分应列举主要数据，并修改英文摘要] 两组患者手术前IMA和cTnI比较均未见统计学差异，术后各时间点试验组的IMA和cTnI明显低于对照组，在t1、t2、t3、t4各时间点，对照组和实验组的IMA分别为80.7±9.7 vs 73.1±12.4（P=0.0002），97.6±9.5 vs 84.8±11.3（P=0.0000），108.7±13.2 vs 90.6±12.9（P=0.0000）和97.6±11.4 vs 88.5±10.6（P=0.0000）。在t1、t2、t3、t4各时间点，对照组和实验组的cTnI分别为0.060±0.020 vs 0.040±0.005（P=0.0000），0.070±0.030 vs 0.050±0.010（P=0.0000），0.070±0.040 vs 0.050±0.008（P=0.0001）和0.070±0.050 vs 0.050±0.010（P=0.0022）。在t1、t2、t3时间点，两组的低频功率（LF）、高频功率（HF）、总功率（TP）均和t0时间点有显著性差异。在t3时间点，试验组LF、HF、TP、LF/HF明显低于对照组。结论 右美托咪定能减轻肺心病患者腹部手术围术期的心肌损伤，改善心率变异性。

Objective To study the myocardial protective effect of Dexmedetomidine in the perioperative period of abdominal operation in patients with pulmonary heart disease. Methods 126 patients who were diagnosed with pulmonary heart disease and accepted abdominal surgery were randomly divided into the experimental group and the control group（63 cases each） from June 2016 to June 2017. The experimental group was treated with dexmedetomidine via venous pump on the basis of anesthesia, and the control group was given the same amount of normal saline. Markers of myocardial injury, including ischemia modified albumin（IMA） and cardiac troponin I （cTnI） were compared before and 0, 6, 12, 24 h after the operation between two groups. Heart rate viability at goes into operation room（t0）, after induction（t1）, operation started immediately（t2） and operation end immediately（t3） were recorded and compared between two groups. Results There was no significant difference in IMA and cTnI between the two groups before operation, and the IMA and cTnI in the experimental group were significantly lower than that of the control group at all time points after operation. IMA in control group and experimental group at t1, t2, t3 and t4 time points were 80.7±9.7 vs 73.1±12.4（P=0.0002）,97.6±9.5 vs 84.8±11.3（P=0.0000）,108.7±13.2 vs 90.6±12.9（P=0.0000）and 97.6±11.4 vs 88.5±10.6（P=0.0000） respectively.cTnI in control group and experimental group at t1, t2, t3 and t4 time points were 0.060±0.020 vs 0.040±0.005（P=0.0000）,0.070±0.030 vs 0.050±0.010（P=0.0000）,0.070±0.040 vs 0.050±0.008（P=0.0001）and 0.070±0.050 vs 0.050±0.010（P=0.0022） respectively. Low frequency power（LF）, high frequency power（HF）, and total power（TP） at t1, t2 and t3 time points had significant differences with those at t0 time points in two groups. At the time point of t3, LF, HF, TP and LF/HF in the experimental group were significantly lower than those in the control group. Conclusion Dexmedetomidine can reduce the myocardial injury during the perioperative period of abdominal operation and improve heart rate variability in patients with pulmonary heart disease.