不同剂量右美托咪定对体外循环心脏瓣膜置换手术患者心肌损伤及血流动力学的影响性研究

Clinical Effects on Myocardial Injury and Hemodynamics of Different Doses of Dexmedetomidine on Patients Undergoing Cardiac Valve Replacement under Cardiopulmonary Bypass

目的:探讨不同剂量右美托咪定对体外循环心脏瓣膜置换手术患者心肌损伤及血流动力学的影响。方法:选取我院2016年3月-2018年3月收治的104例风湿性心脏病患者,随机分为A组(n=35)、B组(n=35)和C组(n=34)。A组给予右美托咪定0.5μg/kg静脉注射,B组给予右美托咪定1μg/kg静脉注射,C组以同等速度注入等量生理盐水。观察比较三组心肌损伤、血流动力学及不良反应发生情况。结果:与用药前比较,三组患者其他时点CK-MB、H-FABP、cTnI水平均显著升高(P<0.05)。CPB停止10min前、术毕、术后8h、术后1d,A组、B组的CK-MB、H-FABP、cTnI水平均低于C组(P<0.05),且A组低于B组(P<0.05)。A组心率在右美托咪定使用时(T1)时刻下降,CPB停止10min(T5)时刻明显升高(P<0.05);B组心率在T1~T4(CPB前)时刻下降,T5时刻明显升高(P<0.05);C组心率在切皮后(T2)、劈胸骨后(T3)、T5时刻明显上升(P<0.05)。A组、B组MAP波动未见统计学差异(P>0.05),C组MAP在T1~T5时刻显著下降(P<0.05)。T1~T4时刻,A组、B组的心率均低于C组(P<0.05),且B组低于A组(P<0.05);T5时刻,B组的心率低于A组及C组(P<0.05)。T1~T5时刻,A组与B组的MAP均高于C组(P<0.05),但A组、B组比较差异无统计学意义(P>0.05)。三组患者不良反应发生情况比较,C组<A组<B组,差异有统计学意义(X^2=6.657,P=0.036)。结论:不同剂量右美托咪定均对体外循环心脏瓣膜置换手术患者心肌损伤及血流动力学产生影响,但0.5μg/kg可最大限度减轻心肌损伤,同时保持血流动力学稳定,不良反应发生率较低,值得临床推广应用。

Objective:This study aims to investigate the clinical effects on myocardial injury and hemodynamics of different doses of dexmedetomidine on patients undergoing cardiac valve replacement under cardiopulmonary bypass.Methods:104 patients in our hospital from March 2016 to March 2018 were randomLy divided into Group A(n=35),Group B(n=35)and Group C(n=34).Group A was given dexmedetomidine 0.5μg/kg intravenous injection,while Group B was given dexmedetomidine 1μg/kg intravenous injection,and Group C was injected saline as the same rate as Group A and Group B.Myocardial injury,hemodynamics and adverse reactions were observed and compared between the groups.Results:Compared with those before treatment,the levels of CK-MB,H-FABP and cTnI at other time points in the three groups were significantly higher(P<0.05).At the time of CPB stopped before 10 min,after operation,8 hafter operation,and 1 Dafter operation,the levels of CK-MB,HFABP and cTnI in Group A and Group B were lower than those in Group C(P<0.05),and those of in Group A were lower than those of in Group B(P<0.05).Heart rate decreased at T1 and obviously increased at T5 in Group A(P<0.05);which decreased at T1-T4 and obviously increased at T5 in Group B(P<0.05)but obviously increased at T2,T3 and T5 in Group C(P<0.05).There was no significant difference in the level of MAP between Group A and Group B(P>0.05).The level of MAP decreased significantly at T1-T5 in Group C(P<0.05).At T1-T4,the heart rate of Group A and Group B was lower than that of Group C(P<0.05),which of Group B was lower than that of Group A(P<0.05).At T5,the heart rate of group B was lower than that of Group A and Group C(P<0.05).At T1-T5,the level of MAP in Group A and Group B was higher than that of Group C(P<0.05);but there was no difference between Group A and Group B(P>0.05).Compared the adverse reactions of three groups,Group C was more than Group A,which was more than Group B,with the difference having statistically significant(X^2= 6.657,P=0.036).Conclusion:Different doses of dexmedetomidine have effects on myocardial injury and hemodynamics in patients undergoing cardiac valve replacement under cardiopulmonary bypass.However,0.5μg/kg can minimize the level of myocardial injury,maintain the stability of hemodynamic and decrease the incidence of adverse reactions.It is worthy of popularization and application.