右美托咪定对冠状动脉旁路移植术患者左室射血分数、血清肌钙蛋白、肿瘤坏死因子-α及白介素-10的影响

Effect of Dexmedetomidine on LVEF, cTn, TNF-α and IL-10 in patients underwent coronary artery bypass grafting

目的探讨右美托咪定对冠状动脉旁路移植术(coronary artery bypass grafting,CABG)患者左室射血分数(left ventricular ejection fraction,LVEF)、血清肌钙蛋白(cardiac troponin,cTn)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-a)及白介素(interleukin,IL)-10的影响。方法选取2013年11月至2017年1月菏泽市立医院收治的于体外循环下行CABG的80例患者为研究对象,采用随机数表法将其分为对照组、低剂量组、中剂量组、高剂量组,每组各20例。低剂量组、中剂量组、高剂量组患者分别于体外循环开始前静脉注射右美托咪定0.5、0.75、1.0μg/kg,对照组患者不进行任何处理。比较四组患者麻醉前、体外循环结束时、手术结束时、术后6小时及术后24小时的LVEF、cTnI、cTnT、TNF-α及IL-10水平。结果体外循环结束时、手术结束时、术后6小时、术后24小时,低剂量组、中剂量组、高剂量组患者LVEF均高于对照组(P<0.05),cTnI、cTnT、TNF-α、IL-10水平均显著低于对照组(P<0.05)。术后6小时和术后24小时,低剂量组、中剂量组、高剂量组患者血清TNF-α、IL-10水平均显著低于手术结束时(P<0.05)。结论静脉注射0.5~1.0μg/kg右美托咪定,对体外循环下行CABG患者的缺血再灌注损伤心肌具有一定的保护作用,其保护机制可能与提高LVEF,降低血清cTnI、cTnT、TNF-α及IL-10水平有关。

Objective To investigate the effect of Dexmedetomidine on left ventricular ejection fraction(LVEF),tumor necrosis factor-α(TNF-α),interleukin-10(IL-10)and serum troponin(cTn)in patients underwent coronary artery bypass grafting(CABG).Method80patients underwent CABG were selected from November2013to January2017in Heze Municiple Hospital as research objects,they were randomly divided into control group,low-dose group(injected0.5μg/kg Dexmedetomidine before extracorporeal circulation),medium-dose group(injected0.75μg/kg Dexmedetomidine before extracorporeal circulation)and high-dose group(injected1.0μg/kg Dexmedetomidine before extracorporeal circulation),patients in control group received no treatment.Before anesthesia,at the end of extracorporeal circulation,at the end of operation,6hours after operation and24hours after operation,LVEF,cTnI,cTnT,TNF-αand IL-10levels were detected and compared.Result At the end of extracorporeal circulation,at the end of operation,6hours after operation and24hours after operation,LVEF of low-dose group,medium-dose group and high-dose group were higher than those of control group(P<0.05).The levels of cTnI,cTnT,TNF-αand IL-10were lower than those of control group(P<0.05).6hours after operation and24hours after operation,levels of TNF-αand IL-10of low-dose group,medium-dose group and high-dose group were lower than those at the end of operation(P<0.05).Conclusion For patients underwent CABG,intravenous inject0.5～1.0μg/kg Dexmedetomidine has a protective effect on myocardial with ischemical reperfusion injury,the mechanism of the protection may be related to the decrease of levels of serum cTnI,cTnT,TNF-αand IL-10and improve the patients with LVEF.