右美托咪定对非体外循环冠状动脉旁路移植术患者心肌的保护作用

Protective Effect of Dexmedetomidine on Myocardium in Patients Undergoing Off-pump Coronary Artery Bypass Grafting

目的探究右美托咪定对非体外循环冠状动脉旁路移植术(OPCABG)患者心肌细胞的保护作用。方法选择2018年9月—2020年6月收治的拟行OPCABG 122例,按照麻醉给药分为对照组和研究组各61例。2组均给予常规麻醉诱导,研究组于麻醉诱导前给予右美托咪定,对照组于麻醉诱导前给予等量0.9%氯化钠注射液。2组均于围术期不同时点检测血流动力学、心肌酶水平,观察手术相关指标及不良反应发生情况。结果在T1~T4时,2组心率、平均动脉压(MAP)均低于同组T0时,且同时点研究组低于对照组(P<0.05);在T5时,2组心率、MAP高于T0时(P<0.05)。T4、T5时,2组肌酸激酶、肌酸激酶同工酶、乳酸脱氢酶、心肌肌钙蛋白I均高于T0时,但研究组低于对照组(P<0.05)。研究组出血量少于对照组,拔管时间、ICU停留时间及住院时间均短于对照组(P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论右美托咪定可维持OPCABG患者血流动力学稳定,保护心肌功能,促进患者术后转归。

Objective To explore the protective effect of Dexmedetomidine on cardiomyocytes in patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods A total of 122 patients planned to undergo OPCABG between September 2018 and June 2020 were selected and divided into control group(n=61)and experimental group(n=61)according to anesthetic administration.Both groups were given routine anesthesia induction.Experimental group was given Dexmedetomidine before anesthesia induction,while control group was given an equal volume of 0.9%Sodium Chloride Injection before anesthesia induction.Levels of hemodynamics and myocardial enzyme were measured at different time points in the perioperative period,and the operative clinical indexes and adverse reactions were observed in two groups.Results At T1-T4,levels of heart rate(HR)and mean arterial pressure(MAP)were significantly lower than those of the same group at T0 in two groups,and the levels in experimental group were significantly lower than those in control group at the same time point(P<0.05).At T5,HR and MAP levels were significantly higher than those at T0 in two groups(P<0.05).At T4 and T5,levels of creatine kinase(CK),creatine kinase isozyme(CK-MB),lactate dehydrogenase(LDH)and cardiac troponin I(cTnI)were significantly higher than those at T0 in two groups,and the levels in experimental group were significantly lower than those in control group(P<0.05).In experimental group,bleeding volume was less,and the extubation time,length of ICU stay and hospital stay were shorter than those in control group(P<0.05).There was no significant difference in incidence rate of adverse reactions between two groups(P>0.05).Conclusion Dexmedetomidine may maintain the hemodynamic stability,protect myocardial function,and promote the postoperative outcomes of OPCABG patients.