右美托咪定联合艾司洛尔在交感电风暴中的作用研究

Clinical study on the role of dexmedetomidine combined with esmolol in sympathetic electrical storm

目的探讨右美托咪定联合艾司洛尔在交感电风暴中抑制交感神经活性的作用。方法选择2015年5月至2017年5月于河南省人民医院心脏中心心内科监护病房(CCU)住院的交感电风暴患者60例,应用随机数字表法分为艾司洛尔组30例和右美托咪定+艾司洛尔组30例。艾司洛尔组给予盐酸艾司洛尔负荷量0. 5 mg/kg静推2 min,其后以0. 05～0. 2 mg·kg^(-1)·min^(-1)持续静脉泵入;右美托咪定+艾司洛尔组先给予盐酸艾司洛尔负荷量0. 5 mg/kg静推2 min,其后联合盐酸右美托咪定注射液按1μg·kg^(-1)·10 min^(-1)静脉泵入,10 min后以0. 5μg·kg^(-1)·h^(-1)维持量泵入。给予患者持续心电监护评估交感电风暴发生,脉搏指示连续心输出量监测(Pi CCO),以心脏指数(CI)、血管外肺水(EVLW)和B型利钠肽(BNP)评估心功能。结果经治疗3 d后,与艾司洛尔组比较,右美托咪定+艾司洛尔组患者心室颤动发生次数显著减少[(1. 33±0. 61)次/d比(2. 40±0. 86)次/d,P=0. 040],血流动力学指标CI、EVLW和血浆BNP均明显改善[(4. 39±0. 70) L·min^(-1)·m^(-2)比(3. 12±0. 17) L·min^(-1)·m^(-2),P=0. 004;(6. 38±0. 69) ml/kg比(7. 67±1. 03) ml/kg,P=0. 037;(2 447. 57±461. 79) pg/ml比(3 637. 40±779. 59) pg/ml,P=0. 045]。结论右美托咪定可有效抑制交感神经活性,联合艾司洛尔治疗交感电风暴效果较好。

Objective To evaluate the inhibition effect of dexmedetomidine combined with esmolol on sympathetic nerve activity in sympathetic electrical storm. Methods A total of 60 patients with sympathetic electrical storm in the Cardiac Internal Care Unit (CCU) of Henan Province People s Hospital from May 2015 to May 2017 were divided into esmolol group (n=30) and dexmedetomidine+esmolol group (n=30) by random number table. Patients in esmolol group were given a loading dose of 0.5 mg/kg of esmolol for two minutes, followed with continuous intravenous injection of 0.05-0.2 mg·kg^-1·min^-1 . Patients in dexmedetomidine+esmolol group were given 0.5 mg/kg of esmolol for two minutes, followed with dexmetomidine by intravenous injection of 1 μg·kg^-1 ·10 min^-1 and maintenance dose of 0.5 μg·kg^-1 ·h^-1 . All of the patients were given continuous ECG monitoring to assess the occurrence of sympathetic electrical storm. Hemodynamic changes of cardiac index (CI), extravascular lung water (EVLW) were accessed by pulse indicator continuous cardiac output monitoring (PICCO) method and plasma brain natriuretic peptide (BNP) were recorded for evaluation of the cardiac function. Results After 3-d treatment, the frequency of sympathetic electrical storm was significantly reduced in the dexmedetomidine+esmolol group compared with the esmolol group [(1.33±0.61) times daily vs.(2.40±0.86) times daily, P=0.040], CI, EVLW and plasma BNP were significantly improved [(4.39±0.70)L·min^-1 ·m^-2 vs.(3.12±0.17) L·min^-1 ·m^-2 , P=0.004;(6.38±0.69)ml/kg vs.(7.67±1.03)ml/kg, P=0.037;(2 447.57±461.79)pg/ml vs.(3 637.40±779.59)pg/ml, P=0.045]. Conclusions Dexmedetomidine may effectively inhibit the sympathetic activity. Combined with esmolol may have better effect.