右美托咪定对老年房颤非心脏手术患者心肌功能保护及脑保护的作用

Protective effect of dexmedetomidine on myocardial function and brain in elderly patients with atrial fibrillation undergoing noncardiac surgery

目的探讨右美托咪定对老年房颤非心脏手术患者心肌功能保护及脑保护的作用。方法随机数字表法将2019年5月至2020年5月80例于南通大学附属医院拟行非心脏手术的老年房颤患者分为观察组与对照组各40例。对照组给予常规麻醉诱导,观察组在对照组基础上使用右美托咪定。入室时、气管插管时、气管插管后10 min测定两组血流动力学指标〔心率(HR)、平均动脉压(MAP)〕,入室时、气管插管后10 min测定两组心肌缺血损伤相关指标〔心肌肌钙蛋白(cTn)I、N端前脑钠肽(NT-ProBNP)〕、脑损伤相关指标〔S100β蛋白、神经元特异性烯醇化酶(NSE)〕,结束后记录两组心血管事件发生情况。结果入室时,两组HR、MAP比较差异无统计学意义(P>0.05);两组HR均在气管插管时降低,在气管插管后10 min回升,组间比较差异无统计学意义(P>0.05);两组MAP均在气管插管时降低,在气管插管后10 min回升,但观察组高于对照组,差异有统计学意义(P<0.05);气管插管后10 min,两组cTnI、NT-Pro BNP均上升,但观察组低于对照组,差异有统计学意义(P<0.05);气管插管后10 min,两组S100β、NSE均上升,但观察组低于对照组,差异有统计学意义(P<0.05);两组心血管事件发生率比较差异无统计学意义(P>0.05)。结论右美托咪定的使用利于稳定老年房颤非心脏手术患者血流动力学,具有心肌功能保护及脑保护的作用,且不增加心血管事件。

Objective To investigate the effects of dexmedetomidine on myocardial function and brain protection in elderly patients with atrial fibrillation undergoing noncardiac surgery.Methods A total of 80 elderly patients with atrial fibrillation scheduled for noncardiac surgery were randomly divided into observation group and control group,40 cases in each group.The control group was given routine anesthesia induction,and the observation group was given dexmedetomidine on the basis of the control group.The hemodynamic indexes〔heart rate(HR),mean arterial pressure(MAP)〕were measured at the time of entering the room,tracheal intubation and 10 minutes after tracheal intubation.The indexes related to myocardial ischemia injury〔cardiac troponin(cTn)I,N-terminal pro brain natriuretic peptide(NT ProBNP)〕and brain injury related indicators〔S100βprotein,neuron specific enolase(NSE)〕were measured at the time of entering the room and 10 minutes after tracheal intubation.The incidence of cardiovascular events was recorded after the treatment.Results There was no significant difference in HR and MAP between the two groups when entering the room(P>0.05);HR of the two groups decreased during endotracheal intubation,and increased after endotracheal intubation 10 minutes,and there was no significant difference between the two groups(P>0.05);MAP of the two groups decreased during endotracheal intubation,and increased after endotracheal intubation 10 minutes,but that of the observation group was significantly higher than that of the control group(P<0.05),after intubation 10 minutes,cTnI and NT Pro BNP in the two groups increased,but those of the observation group were significantly lower than those of the control group(P<0.05);after intubation 10 minutes,S100βand NSE in the two groups increased,but those of the observation group were significantly lower than those of the control group(P<0.05).There was no significant difference in the incidence of cardiovascular events between the two groups(P>0.05).Conclusions Dexmedetomidine is beneficial to stabilize hemodynamics in elderly patients with atrial fibrillation undergoing noncardiac surgery.It could protect myocardial function and brain without increasing cardiovascular events.