右美托咪定对合并冠心病的老年髋/膝关节置换术患者围手术期心肌损伤的影响

Effect of dexmedetomidine on perioperative myocardial injury in elderly patients with coronary heart disease undergoing hip or knee arthroplasty

目的:探讨右美托咪定对合并冠心病的老年髋/膝关节置换术患者围手术期心肌损伤的影响。方法:选取80例行髋/膝关节置换术的老年冠心病患者作为研究对象,按照麻醉方式不同将患者分为对照组与右美托咪定组,每组各40例。两组患者均实施蛛网膜下腔与硬脊膜外联合麻醉,术中右美托咪定组予以右美托咪定持续泵注;对照组予以等量生理盐水泵注。分别于术前、手术切皮后30 min及术毕检测并比较两组患者血浆氨基末端B型脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTn)I水平;记录并比较两组患者术前、手术切皮后30 min及术毕时平均动脉压(MAP)、心率(HR);记录并比较两组术后30 min镇静-躁动评分(SAS)和术后4 h疼痛视觉模拟评分(VAS);记录并比较两组术后48 h内不良反应发生情况及术后住院时间。结果:与术前比较,两组患者手术切皮后30 min及术毕时血清CK-MB、cTnI及NT-proBNP水平均增高(P<0.05),但右美托咪定组30 min CK-MB、cTnI及NT-proBNP水平低于对照组(P<0.05)。与对照组比较,右美托咪定组在手术切皮后30 min和术毕时MAP和HR均降低(P<0.05),术后30 min SAS评分和术后4 h VAS评分均降低(P<0.05)。两组术后48 h内不良反应发生率无统计学差异(P>0.05)。右美托咪定组术后住院时间略短于对照组,但差异无统计学意义(P>0.05)。结论:右美托咪定对合并冠心病的老年髋/膝关节置换术患者围手术期心肌损伤具有保护作用,有利于患者术后恢复。

Objective:To investigate the effect of dexmedetomidine on perioperative myocardial injury in elderly patients undergoing hip or knee arthropl with coronary heart disease.Methods:A total of 80 elderly patients with coronary heart disease undergoing hip or knee arthroplasty were divided into control group and dexmedetomidine group according to different anesthesia methods,with 40 cases in each group.Both groups were given combined subarachnoid and epidural anesthesia.During the operation,the dexmedetomidine group was given continuous infusion of dexmedetomidine,and the control group was pumped with the same amount of normal saline.The plasma levels of N-terminal pro-brain natriuretic peptide(NT-proBNP),creatine kinase isoenzyme(CK-MB)and troponin(cTn)I were detected before operation,30 min after skin incision and at the end of operation.Mean arterial pressure(MAP)and heart rate(HR)were recorded before operation,30 min after skin incision and at the end of operation.The sedation-agitation scale(SAS)score at 30 min after operation and VAS score at 4 h after operation were recorded.Adverse reactions within 48 hours after operation and postoperative hospital stay were recorded and compared between the two groups.Results:Compared with before operation,the levels of serum CK-MB,cTnI and NT-proBNP in the two groups were increased at 30 min after skin incision and at the end of operation(P<0.05),and the levels of serum CK-MB,cTnI and NT-proBNP in the dexmedetomidine group were lower than those in the control group at 30 min after skin incision and at the end of operation(P<0.05).Compared with the control group,MAP and HR were decreased in the dexmedetomidine group at 30 min after skin incision and at the end of operation(P<0.05).Compared with the control group,the SAS score at 30 min after operation and the VAS score at 4 h after operation in the dexmedetomidine group were decreased(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups within 48 hours after operation(P>0.05).The postoperative hospital stay in the dexmedetomidine group was shorter than that in the control group,but the difference was not statistically significant(P>0.05).Conclusion:Dexmedetomidine has a protective effect on perioperative myocardial injury in elderly patients with coronary heart disease undergoing hip or knee arthroplasty,which is beneficial to postoperative recovery.