右美托咪定对冠心病患者骨科手术期间不良心血管事件的影响

The effect of dexmedetomidine on the adverse cardiovascular events during orthopedic surgery in patients with coronary heart disease

目的:探讨右美托咪定对冠心病患者骨科手术期间不良心血管事件的影响。方法:选取2015年3月至2018年3月黄石市中心医院收治的冠心病骨科手术患者200例,依据随机数字表法分为观察组和对照组,比较2组血流动力学、麻醉效果、炎症状态、心肌损伤、不良心血管事件。结果:观察组和对照组麻醉10 min (T_1)、切皮(T_2)、骨折修复(T3)的心率(heart rate, HR)、平均动脉压(mean arterial pressure, MAP)明显低于麻醉前(T_0),观察组T_1、T_2、T_3的HR、MAP明显低于对照组;观察组和对照组T_1、T_2、T_3的Ramsay镇静得分明显高于T_0,观察组T_1、T_2、T_3的Ramsay镇静得分明显高于对照组,差异有统计学意义(P<0.05);观察组和对照组术后24 h的肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)、心肌钙蛋白T (cTnT)、肌酸激酶同工酶(CK-MB)明显高于术前,观察组术后24h的TNF-α、IL-6、cTnT、CK-MB明显低于对照组,差异有统计学意义(P<0.05);观察组术中、术后1个月不良心血管事件发生率明显低于对照组,差异有统计学意义(P<0.05)。结论:右美托咪定可有效改善冠心病骨科手术患者血流动力学、麻醉效果,有利于减轻患者炎症状态、心肌损伤,且可有效减少不良心血管事件的发生,值得临床作进一步推广。

Objective： To investigate the effect of dexmedetomidine on adverse cardiovascular events during orthopaedic surgery in patients with coronary heart disease. Methods： A total of 200 orthopedic surgery patients with coronary heart disease were selected from March 2015 to March 2018 in the Huangshi Central Hospital, according to the random digital table method, They were divided into the observation group and the control group. The hemodynamics, anesthesia effect, inflammatory symptoms , myocardial injury, adverse cardiovascular events were compared in the two groups. Results： The 10 min after anesthesia （T1）, skin cutting （T2）, fracture repair （T3） heart rate （HR） and mean arterial pressure （MAP） in the the observation group and the control group were significantly lower than those in the before anesthesia （T0）; the T1, T2, T2 HR and MAP in the observation group were significantly lower than those in the control group. The T1, T2, T2 Ramsay sedation scores in the observation group and the control group were significantly higher than those in the To; the T1, T2, T2 Ramsay sedation scores in the observation group were significantly higher than those in the control group, the difference was statistically significant （P 〈0. 05） . The 24 h postoperative tumor necrosis factor alpha （TNF-α）, interleukins-6 （IL-6）, cardiac troponin T （cTnT）, creatine kinase isozyme （CK-MB） in the the observation group and the control group were significantly higher than those in the preoperative; the 24 h postoperative TNF-α, IL-6, cTnT, CK-MB in the observation group were significantly lower than those in the control group, the difference was statistically significant （P 〈 0. 05） . The intraoperative and 1 month postoperative incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group, the difference was statistically significant （P 〈0. 05） . Conclusion： Dexmedetomidine can effectively improve the hemodynamics and anesthesia effect in orthopedic surgery patients with coronary heart disease, it is helpful to reduce the inflammatory state and myocardial injury. It can effectively re duce the incidence of adverse cardiovascular events, and be worth for further clinical promotion.