不同剂量右美托咪定对行腹腔镜胃肠手术老年冠状动脉性心脏病患者心肌的保护作用

Protective effect of different doses of dexmedetomidine on the myocardium in patients with coronary heart disease undergoing laparoscopic gastrointestinal surgery

目的观察不同剂量右美托咪定对行腹腔镜胃肠手术冠状动脉性心脏病患者心肌的保护作用。方法选择2019年3月至2021年3月于新乡医学院第一附属医院择期行腹腔镜胃肠手术的80例老年冠状动脉性心脏病患者为研究对象,按照随机数字法将患者分为对照组、0.50μg·kg^(-1)右美托咪定组、0.75μg·kg^(-1)右美托咪定组和1.00μg·kg^(-1)右美托咪定组,每组20例。研究过程中剔除5例患者,最终纳入75例患者进行结果分析。0.50μg·kg^(-1)右美托咪定组、0.75μg·kg^(-1)右美托咪定组、1.00μg·kg^(-1)右美托咪定组患者分别于麻醉诱导前10 min泵注0.50、0.75、1.00μg·kg^(-1)右美托咪定,对照组患者泵注等剂量生理盐水。分别于麻醉诱导前15 min(T_(1))、手术结束时(T_(2))、术后24 h(T_(3))、术后48 h(T_(4))时抽取各组患者外周静脉血5 mL,采用酶联免疫吸附试验测定血清肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、氨基末端B型钠尿肽前体(NT-ProBNP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平。结果4组患者T_(2)、T_(3)时血清中TNF-α、IL-6水平高于T_(1)时(P<0.05)。4组患者T_(4)时与T_(1)时血清中TNF-α、IL-6水平比较差异无统计学意义(P>0.05)。T_(1)时,4组患者血清中TNF-α、IL-6水平比较差异均无统计学意义(P>0.05)。T_(2)、T_(3)时,0.50μg·kg^(-1)右美托咪定组、0.75μg·kg^(-1)右美托咪定组、1.00μg·kg^(-1)右美托咪定组患者血清中TNF-ɑ、IL-6水平低于对照组(P<0.05);T_(4)时,0.50μg·kg^(-1)右美托咪定组、0.75μg·kg^(-1)右美托咪定组、1.00μg·kg^(-1)右美托咪定组与对照组患者血清中TNF-α、IL-6水平比较差异无统计学意义(P>0.05)。T_(2)时,0.75μg·kg^(-1)右美托咪定组、1.00μg·kg^(-1)右美托咪定组患者血清中TNF-α、IL-6水平低于0.50μg·kg^(-1)右美托咪定组(P<0.05);T_(3)、T_(4)时,0.75μg·kg^(-1)右美托咪定组、1.00μg·kg^(-1)右美托咪定组与0.50μg·kg^(-1)右美托咪定组患者血清中TNF-α、IL-6水平比较差异无统计学意义(P>0.05)。T_(2)时,1.00μg·kg^(-1)右美托咪定组患者血清中TNF-α水平低于0.75μg·kg^(-1)右美托咪定组(P<0.05),2组患者血清中IL-6水平比较差异无统计学意义(P>0.05);T_(3)、T_(4)时,1.00μg·kg^(-1)右美托咪定组与0.75μg·kg^(-1)右美托咪定组患者血清中TNF-α、IL-6水平比较差异无统计学意义(P>0.05)。4组患者T_(2)、T_(3)、T_(4)时血清中cTnI、CK-MB、NT-ProBNP水平均高于T_(1)时(P<0.05)。T_(1)时,4组患者血清中cTnI、CK-MB、NT-ProBNP水平比较差异均无统计学意义(P>0.05)。T_(2)、T_(3)、T_(4)时,0.50μg·kg^(-1)右美托咪定组、0.75μg·kg^(-1)右美托咪定组、1.00μg·kg^(-1)右美托咪定组患者血清中cTnI、CK-MB、NT-ProBNP水平均低于对照组(P<0.05)。T_(2)时,0.75μg·kg^(-1)右美托咪定组、1.00μg·kg^(-1)右美托咪定组与0.50μg·kg^(-1)右美托咪定组患者血清中cTnI、CK-MB、NT-ProBNP水平比较差异均无统计学意义(P>0.05);T_(3)、T_(4)时,0.75μg·kg^(-1)右美托咪定组、1.00μg·kg^(-1)右美托咪定组患者血清中cTnI、CK-MB水平高于0.50μg·kg^(-1)右美托咪定组(P<0.05)。T_(3)时,0.75μg·kg^(-1)右美托咪定组、1.00μg·kg^(-1)右美托咪定组患者血清中NT-ProBNP水平高于0.50μg·kg^(-1)右美托咪定组(P<0.05)。T_(4)时,0.75μg·kg^(-1)右美托咪定组与0.50μg·kg^(-1)右美托咪定组患者血清中NT-ProBNP水平比较差异无统计学意义(P>0.05);1.00μg·kg^(-1)右美托咪定组患者血清中NT-ProBNP水平高于0.50μg·kg^(-1)右美托咪定组(P<0.05)。0.75μg·kg^(-1)右美托咪定组与1.00μg·kg^(-1)右美托咪定组患者各时间点血清中cTnI、CK-MB、NT-ProBNP水平比较差异均无统计学意义(P>0.05)。结论冠状动脉性心脏病患者行腹腔镜胃肠手术时使用0.50μg·kg^(-1)右美托咪定对患者的心肌具有较好的保护作用。

Objective To observe the protective effect of different doses of dexmedetomidine on myocardium in patients with coronary heart disease undergoing laparoscopic gastrointestinal surgery.Methods Eighty elderly patients with coronary heart disease who underwent elective laparoscopic gastrointestinal surgery in the First Affiliated Hospital of Xinxiang Medical University from March 2019 to March 2021 were selected as the study subjects.The patients were divided into the control group,0.50μg·kg^(-1) dexmedetomidine group,0.75μg·kg^(-1) dexmedetomidine group and 1.00μg·kg^(-1) dexmedetomidine group according to the random number table,with 20 cases in each group.Five patients were excluded from the study,and 75 patients were included in the result analysis.The patients in the 0.50μg·kg^(-1) dexmedetomidine group,0.75μg·kg^(-1) dexmedetomidine group and 1.00μg·kg^(-1) dexmedetomidine group were pumped with 0.50,0.75,1.00μg·kg^(-1) dexmedetomidine at 10 min before induction of anesthesia,respectively;the patients in the control group were pumped with equal volume of normal saline.The 5 mL of peripheral venous blood were collected at 15 minutes before induction of anesthesia(T_(1)),the end of surgery(T_(2)),24 hours after surgery(T_(3)),and 48 hours after surgery(T_(4)),and the serum cardiac troponin I(cTnI),creatine kinase-MB(CK-MB),N-terminal pro-B-type natriuretic peptide(NT-ProBNP),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)levels were determined by enzyme-linked immunosorbent assay.Results The serum levels of TNF-αand IL-6 of patients in the four groups at T_(2) and T_(3) were significantly higher than those at T_(1)(P<0.05).There was no significant difference in the serum levels of TNF-αand IL-6 of patients in the four groups between the T_(1) and T_(4) time point(P>0.05).There was no significant difference in the serum levels of TNF-αand IL-6 of patients among the four groups at T_(1) time point(P>0.05).At T_(2) and T_(3) time point,the serum levels of TNF-αand IL-6 of patients in the 0.50μg·kg^(-1) dexmedetomidine group,0.75μg·kg^(-1) dexmedetomidine group and 1.00μg·kg^(-1) dexmedetomidine group were significantly lower than those in the control group(P<0.05).At T_(4) time point,there was no significant difference in the serum levels of TNF-αand IL-6 of patients between the 0.50μg·kg^(-1) dexmedetomidine group,0.75μg·kg^(-1) dexmedetomidine group,1.00μg·kg^(-1) dexmedetomidine group and control group(P>0.05).At T_(2) time point,the serum levels of TNF-αand IL-6 of patients in the 0.75μg·kg^(-1) dexmedetomidine group,1.00μg·kg^(-1) dexmedetomidine group were significantly lower than those in the 0.50μg·kg^(-1) dexmedetomidine group(P<0.05).At T_(3) and T_(4) time point,there was no significant difference in the serum levels of TNF-αand IL-6 of patients between the 0.75μg·kg^(-1) dexmedetomidine group,1.00μg·kg^(-1) dexmedetomidine group and the 0.50μg·kg^(-1) dexmedetomidine group(P>0.05).At T_(2) time point,the serum level of TNF-αof patients in the 1.00μg·kg^(-1) dexmedetomidine group was significantly lower than that in the 0.75μg·kg^(-1) dexmedetomidine group(P<0.05);there was no significant difference in the serum level of IL-6 of patients between the above two groups(P>0.05).At T_(3) and T_(4) time point,there was no significant difference in the serum levels of TNF-αand IL-6 of patients between the 1.00μg·kg^(-1) dexmedetomidine group and 0.75μg·kg^(-1) dexmedetomidine group(P>0.05).The serum levels of cTnI,CK-MB,NT-ProBNP of patients in the four groups at T_(2),T_(3),T_(4) were significantly higher than those at T_(1)(P<0.05).At T_(1) time point,there was no significant difference in the serum levels of cTnI,CK-MB,NT-ProBNP of patients among the four groups(P>0.05).At T_(2),T_(3) and T_(4) time point,the serum levels of cTnI,CK-MB,NT-ProBNP of patients in the 0.50μg·kg^(-1) dexmedetomidine group,0.75μg·kg^(-1) dexmedetomidine group,1.00μg·kg^(-1) dexmedetomidine group were significantly lower than those in the control group(P<0.05).At T_(2) time point,there was no significant difference in the serum levels of cTnI,CK-MB,NT-ProBNP of patients between the 0.75μg·kg^(-1) dexmedetomidine group,1.00μg·kg^(-1) dexmedetomidine group and the 0.50μg·kg^(-1) dexmedetomidine group(P>0.05);at T_(3) and T_(4) time point,the serum levels of cTnI,CK-MB of patients in the 0.75μg·kg^(-1) dexmedetomidine group and 1.00μg·kg^(-1) dexmedetomidine group were significantly higher than those in the 0.50μg·kg^(-1) dexmedetomidine group(P<0.05).At T_(3) time point,the serum level of NT-ProBNP of patients in the 0.75μg·kg^(-1) dexmedetomidine group and 1.00μg·kg^(-1) dexmedetomidine group was significantly higher than that in the 0.50μg·kg^(-1) dexmedetomidine group(P<0.05).At T_(4) time point,there was no significant difference in the serum level of NT-ProBNP of patients between the 0.75μg·kg^(-1) dexmedetomidine group and the 0.50μg·kg^(-1) dexmedetomidine group(P>0.05);the serum level of NT-ProBNP of patients in the 1.00μg·kg^(-1) dexmedetomidine group was significantly higher than that in the 0.50μg·kg^(-1) dexmedetomidine group(P<0.05).There was no significant difference in the serum levels of cTnI,CK-MB,NT-ProBNP of patients between the 0.75μg·kg^(-1) dexmedetomidine group and the 1.00μg·kg^(-1) dexmedetomidine group at each time point(P>0.05).Conclusion The application of 0.50μg·kg^(-1) dexmedetomidine in patients with coronary heart disease undergoing laparoscopic astrointestinal surgery has a good protective effect on the myocardium of patients.