右美托咪啶对急性心肌梗死患者急诊行介入治疗的保护作用

Protective effect of dexmedetomidine on emergency percutaneous coronary intervention in patients with acute myocardial infarction

目的观察右美托咪啶在急诊冠状动脉介入(PCI)治疗中对急性心肌梗死的心肌保护作用。方法收集2015年8月1日至2016年3月31日就诊于新乡市中心医院急诊行PCI治疗的急性ST段抬高心肌梗死患者86例,随机分成右美托咪啶组和对照组各43例,所有患者均接受急诊PCI治疗,右美托咪啶组于患者入院后常规给予右美托咪啶负荷量0.3~0.6μg/kg,继续微量泵静脉泵入0.2~0.3μg/(kg·h),维持术后24 h。对照组:给予静脉注射吗啡3 mg,必要时间隔5 min重复一次,总量不超过15 mg。两组分别于术前、术后12 h、术后24 h测定肌钙蛋白I、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)浓度,术前、术后24 h测定N末端B型利钠肽原浓度以及床旁心脏彩超测量左室射血分数。结果两组在术前血清肌钙蛋白I、肌酸激酶、肌酸激酶同工酶、N末端B型利钠肽原浓度以及左室射血分数比较差异无统计学意义(P>0.05),两组在术后12 h血清肌钙蛋白I、肌酸激酶、肌酸激酶同工酶浓度比较差异有统计学意义(P<0.05),两组在术后24 h血清肌钙蛋白I、肌酸激酶、肌酸激酶同工酶、N末端B型利钠肽原浓度以及左室射血分数比较比较差异有统计学意义(P<0.05)。结论静脉应用右美托咪啶对于急性心肌梗死行PCI治疗的患者有镇静、镇痛作用,可以明显缓解患者焦虑,稳定血流动力学,减轻心肌的进一步损伤,改善心肌功能,对心肌有保护作用。

Objective:To observe the protective effects of dexmedetomidine on acute myocardial infarction in percutaneous coronary intervention(PCI).Methods:Eighty six cases of acute ST segment elevation myocardial infarction patients from August1,2015to March31,2016were treated with emergency PCI in Xinxiang Central Hospital of Henan province,and were randomly divided into dexmedetomidine group(43cases)and control group(43cases).All the patients underwent emergency PCI treatment.In the dexmedetomidine group,the patients who were admitted to hospital after treated with dexmedetomidine loading dose(0.3~0.6μg/kg)continued infusing in vein by micro pump(0.2~0.3μg/kg·h),which was maintained24hours after operation.In the control group morphine3mg intravenous injection was used and when necessary it was repeated for once every5min,and the total amount was not more than15mg.The concentrations of troponin I,creatine kinase and creatine kinase isoenzyme were measured.The N terminal B type natriuretic peptide in serum was measured,and left ventricular ejection fraction bedside echocardiography was measured in preoperative,postoperative12hours and postoperative24hours.Results:The difference of two groups was no statisticaliy significancnt in the concentration of troponin I and creatine kinase,creatine kinase isoenzyme,the N-terminal B type natriuretic peptide in serum and bedside echocardiography for measuring left ventricular ejection fraction on preoperative(P>0.05),the difference of two groups was statistically significant in postoperative12hours(P<0.05),and the difference of two groups was statistically significant in24hours(P<0.05).Conclusion:Intravenous dexmedetomidine has sedative and analgesic effect on patients with acute myocardial infarction,which can relieve patients anxiety,stabilize hemodynamics,reduce further damage to myocardium,improve cardiac function and protect cardiac muscle.