右美托咪啶靶控输注对臂丛神经阻滞高血压患者心肌损伤的影响

Effect of target controlled infusion of dexmedetomidine on myocardial injury in patients with hypertension of the brachial plexus block

目的探讨右美托咪啶靶控输注对臂丛神经阻滞高血压患者心肌损伤的影响及安全性。方法选取南京鼓楼医院集团仪征医院2018年5月至2019年10月择期行臂丛神经阻滞高血压患者44例,随机分为实验组和对照组,每组22例。实验组给予右美托咪啶靶控输注负荷剂量0.8μg/kg,维持0.4μg/(kg·h),负荷剂量输注完毕行B超引导肌间沟臂丛神经阻滞,对照组给予同等剂量NS输注,比较两组CK-MB、hs-CRP、AST、MAP、HR指标水平及不良反应发生率。结果T_(0)时,两组CK、CK-MB、HBDH、hs-CRP、AST比较差异无统计学意义;T_(4)、T_(5)时,实验组CK、CK-MB、HBDH、hs-CRP、AST均明显低于对照组(P<0.05);T_(4)、T_(5)时,对照组CK、CK-MB、HBDH、HS-CRP均明显高于T_(0)时(P<0.05),T_(5)时,实验组CK、CK-MB、HBDH、hs-CRP、AST明显低于T_(0)时(P<0.05)。两组c TnI均为阴性。T_(0)时,两组HR、MAP比较差异无统计学意义;T_(1)、T_(2)、T_(3)时,实验组MAP、HR均明显低于对照组(P<0.05),实验组术中(T_(1)、T_(2)、T_(3))MAP、HR明显低于给药前(T_(0)),差异有统计学意义(P<0.05),对照组术中(T_(1),T_(2))MAP、HR均明显高于给药前(T_(0)),差异有统计学意义(P<0.05)。两组心动过缓、呼吸抑制、恶心呕吐、室性早搏和尿储留发生率比较差异无统计学意义;实验组心动过速发生率低于对照组(P<0.05)。结论右美托咪啶靶控输注臂丛神经阻滞血压,患者心率更平稳,且hs-CRP、cTnI、CK-MB术后无明显升高,具有保护心肌作用。

Objective To explore the effect and safety of target controlled infusion of dexmedetomidine on myocardial injury in patients with hypertension of the brachial plexus block.Methods 44 cases of hypertension patients with selective brachial plexus block from May 2018 to October2019 in Yizheng Hospital of Nanjing Drum Tower Hospital Group were selected.They were randomly divided into experimental group and control group,with 22 cases in each group.The experimental group was given target controlled infusion of dexmedetomidine at loading dose of 0.8μg/kg and maintained at 0.4μg/(kg·h),and after the loading dose infusion was completed,B-guided intermuscular brachial plexus block was performed.The control group was given the same dose of NS infusion.The CK-MB,hs-CRP,AST,MAP,HR index levels and the incidence of adverse reactions were compared between the two groups.Results At T_(0),there was no significant difference in the CK,CK-MB,HBDH,hs-CRP,and AST between the two groups;at T_(4) and T_(5),the CK,CK-MB,HBDH,hs-CRP,and AST in the experimental group were all significant lower than the control group(P<0.05);at T_(4),T_(5),the CK,CK-MB,HBDH,hs-CRP in the control group were significantly higher than at T_(0)(P<0.05),at T_(5),the CK,CK-MB HBDH,hs-CRP and AST in the experimental group were significantly lower than at T_(0)(P<0.05).Both groups of cTnI were negative.At T_(0),there was no significant difference in HR and MAP between the two groups;at T_(1),T_(2),and T_(3),the MAP and HR of the experimental group were significantly lower than those of the control group(P<0.05),and intraoperative(T_(1),T_(2),T_(3))MAP and HR of the experimental group were significantly lower than those before administration(T_(0)),and the difference was statistically significant(P<0.05).Intraoperative(T_(1),T_(2))MAP and HR of the control group were significantly higher Before administration(T_(0)),the difference was statistically significant(P<0.05).There was no significant difference in the incidence of bradycardia,respiratory depression,premature ventricular contractions,nausea and vomiting and urine retention between the two groups;the incidence of tachycardia in the experimental group was lower than in the control group(P<0.05).Conclusion Target controlled infusion of dexmedetomidine in patients with hypertension accepted brachial plexus block is more stable in blood pressure and heart rate,and has obvious myocardial protective effect.