静脉麻醉复合右美托咪定对冠状动脉搭桥术患者心肝肾的保护作用

Protective effect of intravenous anesthesia combined with dexmedetomidine on heart,liver and kidney in patients undergoing coronary artery bypass grafting

目的观察静脉麻醉复合右美托咪定对体外循环下行冠状动脉搭桥术患者围手术期心肝肾的保护作用。方法选择2016年6月—2017年6月河北医科大学第三医院心外科行体外循环下冠状动脉搭桥术冠心病患者90例,随机数字表法分为对照组(C组)和盐酸右美托咪定组(D组),每组45例。2组均予全凭静脉麻醉及常规体外循环下行冠状动脉搭桥术。而D组在切皮前30 min静脉泵注右美托咪定。记录患者在给药前即刻(T0)、给药后10 min(T1)、30 min(T2)、1 h(T3)、3 h(T4)、6 h(T5)的收缩压(SBP)、舒张压(DBP)和心率(HR)变化,术前及术后8 h、12 h、24 h、48 h、72 h检测心肌肌钙蛋白(cTnI)和血清肌酸激酶同工酶(CK-MB)心肌损伤标志物含量,手术前24 h和手术后24 h血清炎性因子水平[高敏C反应蛋白(hs-CRP)和中性粒细胞计数(ANC)];术前和术后1个月检测左心室射血分数(LVEF)及室壁运动计分指数(WMSI)等心功能指标;记录术前和术后24 h丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清肌酐(SCr)、血尿素氮(BUN)、胱抑素C(CysC)等肝肾功能指标的变化。结果与C组比较,D组患者的收缩压和舒张压及心率均明显下降(F/P=7.125/0.029、7.620/0.020、6.340/0.034);D组患者心肌损伤标志物cTnI、CK-MB明显降低(F/P=10.037/0.000、8.310/0.047),而心功能指标LVEF、WMSI明显改善(t/P=20.091/<0.001、4.930/<0.001)。D组术后肾功能较C组有所改善(t/P=7.495/<0.001、10.430/<0.001、4.939/<0.001),hs-CRP、ANC等炎性相关因子较C组降低(t/P=30.855/<0.001、11.385/<0.001),机械通气时间短于C组(t/P=6.882/<0.001),术后Ramsay镇静评分明显高于C组(U/P=5.674/0.001)。结论右美托咪定能够降低炎性反应,减少心肾功能损伤,改善焦虑情绪,可安全有效地应用于冠状动脉搭桥术患者。

Objective To observe the protective effect of intravenous anesthesia combined with dexmedetomidine on heart,liver and kidney in patients undergoing coronary artery bypass grafting.Methods From June 2016 to June 2017,the Third Hospital of Hebei Medical University Department of anesthesia for coronary heart disease in off-pump coronary artery bypass grafting anesthesia in 90 patients as the research object,randomly divided into control group(group C)and dexmedetomidine hydrochloride treatment group(group D),2 groups were given conventional coronary artery bypass grafting,D group were treated with intravenous micro injection of dexmedetomidine.Recorded all patients’systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)before(T0)and after administration of 10 min(T1)、30 min(T2)、1 h(T3)、3 h(T4)、6 h(T5)preoperative and postoperative 8 h,12 h,24 h,48 h,72 h of cardiac troponin I(IcTnI)and serum creatine kinase isoenzyme(CK-MB)content,24h before surgery and after surgery 24h the level of serum inflammatory factor[hypersensitive C reactive protein(hs-CRP)levels and neutrophil count(ANC)];preoperative and postoperative 1 months were examined by echocardiography cardiac function:left ventricular ejection fraction(LVEF)and wall motion score index(WMSI)recorded before and during operation;after 24h of liver and kidney function changes of alanine aminotransferase(ALT)and aspartate aminotransferase(AST),serum creatinine(SCr),blood urea nitrogen(BUN),Cystatin C(CysC).Results Compared with group C,systolic blood pressure,diastolic blood pressure and heart rate in group D decreased significantly(F/P=7.125/0.029,7.620/0.020,6.340/0.034);myocardial injury markers in group D were significantly lower than those in control group(F/P=10.037/0.000,8.310/0.047),while heart function indicators such as LVEF and WMSI were significantly higher(t/P=20.091/<0.001,4.930/<0.001).After operation,kidney function in group D were improved(t/P=7.495/<0.001,10.430/<0.001,4.939/<0.001),inflammatory related factors hs-CRP,ANC were decreased(t/P=30.855/<0.001,11.385/<0.001),mechanical ventilation time was significantly shorter than that in group C(t/P=6.882/<0.001).Rasay sedation score in group D was significantly higher than that in group C(U/P=5.674/0.001).Conclusion Dexmedetomidine can reduce inflammation,reduce heart and kidney function damage,improve anxiety,and can be safely and effectively used in patients undergoing coronary artery bypass grafting.