右美托咪定对合并肺源性心脏病手术患者心肌微循环状态和血小板参数水平的影响

Influence of dexmedetomidine on myocardial micro-circulation and platelet parameters in patients undergoing surgery complicated with pulmonary heart disease

目的研究右美托咪定对合并肺源性心脏病手术患者心肌微循环状态和血小板参数水平的影响。方法前瞻性选取92例择期进行手术的合并肺源性心脏病患者,随机数字表法分为观察组(47例)和常规组(45例),观察组麻醉诱导后给予右美托咪定静脉输注,常规组按相同速度给予等量的0.9%氯化钠注射液。比较两组患者术前(T_(0))、麻醉诱导时(T_(1))、术毕即刻(T_(2))、术毕12 h(T_(3))和术毕24 h(T_(4))的血流动力学指标、心肌微循环状态、血小板参数水平和心肺功能变化,并统计围术期不良反应情况。结果两组患者心率(HR)不同时间点组间比较差异均有统计学意义(F分别=50.93、5.36,P均<0.05),平均动脉压(MAP)水平的组间、时间以及交互效应比较,差异均有统计学意义(F分别=25.21、10.26、5.64,P均<0.05)。观察组T2时HR水平明显低于常规组,T_(1)、T_(2)时MAP水平明显高于常规组(t分别=2.70、3.37、5.30,P均<0.05);两组患者肌酸激酶同工酶(CK-MB)、肌钙蛋白-I(cTnI)水平在时间、组间以及交互效应上比较,差异均有统计学意义(F分别=12.73、23.03、2.99;28.43、90.60、8.45,P均<0.05),观察组患者T_(3)、T_(4)时CK-MB、cTnI水平均明显低于常规组(t分别=2.70、2.24、3.83、5.61,P均<0.05),T_(4)时最小腔径(MLD)、平均血流速度(MFV)水平均明显高于常规组(t分别=3.14、5.33,P均<0.05);两组患者血小板体积分布宽度(PDW)、血小板平均体积(MPV)水平在组间、时间和交互效应比较,差异均有统计学意义(F分别=15.05、34.36、22.00;12.52、73.65、7.68,P均<0.05),观察组患者T4时PDW、MPV水平均明显低于常规组(t分别=8.80、6.24,P均<0.05);观察组T4时心脏指数(CI)、肺顺应性水平均明显高于常规组(t分别=3.67、4.91,P均<0.05);两组围术期不良反应发生率比较,差异无统计学意义(χ^(2)=0.19,P>0.05)。结论右美托咪定可改善合并肺源性心脏病手术患者心肌微循环状态和血小板参数水平,维持血流动力学稳定性,促进心肺功能的恢复,且安全性较好。

Objective To study the influence of dexmedetomidine on myocardial micro-circulation and platelet param-eters in patients undergoing surgery complicated with pulmonary heart disease.Methods A total of 92 patients with pul-monary heart disease treated by elective surgery.Using random number table method,the patients were divided into obser-vation group(47 cases)and routine group(45 cases).Patients in the observation group were given intravenous infusion of dexmedetomidine after anesthesia induction,while patients in the routine group were given the same volume of 0.9% chlorine sodium.Changes of hemodynamic indicators,myocardial micro-circulation,platelet parameters and cardiopulmo-nary function at before operation(T_(0)),anesthesia induction(T_(1)),immediately after operation(T_(2)),12h after operation(T_(3))and 24h after operation(T_(4))were compared between the two groups,and perioperative adverse reactions were count-ed.Results There were significant differences in heart rate(HR)in terms of inter-group effect and time effect(F=50.93,5.36,P<0.05).There were statistically signif-icant differences in mean arterial pressure(MAP)in terms of inter-group effect,time effect and interac-tion effect(F=25.21,10.26,5.64,P<0.05).Compared with the routine group,the observation group had significantly lower HR at T_(2) and the significantly higher MAP at T_(1) and T_(2)(t=2.70,3.37,5.30,P<0.05).There were statistically significant differences in the levels of creatine kinase iso-enzyme(CK-MB)and troponin-I(cTnI)in terms of inter-group effect,time effect and interaction effect(F=12.73,23.03,2.99,28.43,90.60,8.45,P<0.05).The levels of CK-MB and cTnI in the observation group at T_(3) and T_(4) were sig-nificantly lower than those in the routine group(t=2.70,2.24,3.83,5.61,P<0.05),the minimal lumen diameter(MLD)and mean flow velocity(MFV)at T_(4) were significantly higher than those in the routine group(t=3.14,5.33,P<0.05).There were statistically significant differences in platelet distribution width(PDW)and mean platelet volume(MPV)in terms of inter-group effect,time effect and interaction effect(F=15.05,34.36,22.00,12.52,73.65,7.68,P<0.05).The PDW and MPV in the observation group at T_(4) were significantly lower than those in the routine group(t=8.80,6.24,P<0.05).At T_(4),the observation group had significantly higher cardiac index(CI)and lung compliance than the routine group(t=3.67,4.91,P<0.05).There was no significant difference in the incidence of perioperative adverse reactions be-tween the two groups(χ^(2)=0.19,P>0.05).Conclusion Dexmedetomidine can improve myocardial micro-circulation and platelet parameters,maintain hemodynamic stability,promote the recovery of cardiopulmonary function in patients under-going surgery for pulmonary heart disease,with good safety.