右美托咪定对冠状动脉旁路移植术老年患者心脑功能的影响

Effect of Dexmedetomidine on cardiac and cerebral function in elderly patients undergoing coronary artery by pass grafting

目的探讨不同剂量右美托咪定对接受体外循环下冠状动脉旁路移植术治疗的老年患者的心脑功能保护作用。方法收集2018年1月至2020年12月在河北省唐山市工人医院接受体外循环下冠状动脉旁路移植术治疗的199例老年患者,随机分为高剂量组(n=67)、低剂量组(n=66)和对照组(n=66)。比较3组患者术前、术中和术后的血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、脑组织氧饱和度(SctO_(2))变化情况及术后1年内桥血管通畅率的差异。结果3组患者术前基线资料差异无统计学意义(均P>0.05)。机械通气30 min时高剂量组患者SctO_(2)(65.46%±3.18%)高于低剂量组(58.35%±2.83%)和对照组(50.52%±2.35%)(P<0.05);术后24 h高剂量组尿量[(1597.76±469.18)mL]最多(P<0.05)。术后48 h,高剂量组的cTnI[(1.58±0.43)ng/mL]和CK-MB水平[(17.36±2.45)ng/mL]低于其他两组[分别为(2.41±0.55)ng/mL和(2.62±0.52)ng/mL,(22.84±3.18)ng/mL和(25.42±3.84)ng/mL,P<0.05],尽管高剂量组拔管时间和重症监护病房住院时间延长,但总住院时间3组患者间差异无统计学意义(P>0.05)。术后1年内高剂量组、低剂量组、对照组桥血管通畅率分别为89.55%、87.36%和83.33%,差异无统计学意义(P>0.05)。结论高剂量右美托咪定可减少术后心肌损伤,防止术中SctO_(2)降低,值得临床推广。

Objective To investigate the protective effects of different doses of Dexmedetomidine on cardiac and brain function in elderly patients undergoing coronary artery bypass grafting with cardiopulmonary bypass(CABG-CBP).Methods A total of 199 elderly patients who underwent CABG-CBP in Tangshan Workers'Hospital from January 2018 to December 2020 were prospectively selected.They were randomly divided into high-dose group(n=67),low-dose group(n=66)and control group(n=67).The preoperative,intraoperative and postoperative clinical data were compared.The changes of cardiac troponin I(cTnI),creatine kinase isoenzyme MB(CK-MB)and cerebral tissue oxygen saturation(SctO_(2))were analyzed to evaluate the function of cardiac and brain.Results There was no significant difference in preoperative baseline data among the 3 groups(all P>0.05).After 30 min of mechanical ventilation,the level of SctO_(2)in high-dose group was higher(65.46%±3.18%)than that in low-dose group(58.35%±2.83%)and control group(50.52%±2.35%).The highest urine volume was found in high-dose group(1597.76±469.18 mL)24 h after surgery(P<0.05).Forty-eight hours after operation,the levels of serum cTnI(1.58±0.43 ng/mL)and CK-MB(17.36±2.45 ng/mL)in high-dose group were lower than those in the other two groups(2.41±0.55 ng/mL and 2.62±0.52 ng/mL,22.84±3.18 ng/mL and 25.42±3.84 ng/mL,P<0.05).Although the extubation time and ICU hospitalized duration in high-dose group were prolonged,there was no significant difference in the total hospitalized duration among the three groups(P>0.05).There was no significant difference in the patency of the bridging vessels among the three groups 1 year after surgery(89.55%,87.36%,83.33%,P>0.05).Conclusion The high dose dexmedetomidine can reduce myocardial injury and prevent the decrease of SctO_(2),which is worthy of clinical promotion.