右美托咪定对非体外循环冠状动脉旁路移植术后心肌保护作用的影响

Effect of dexmedetomidine on myocardial protection after off-pump coronary artery bypass transplantation

目的探讨右美托咪定在非体外循环冠状动脉旁路移植术中的应用,并探讨对心肌的保护作用。方法选取2023年1月—2023年6月郑州市第七人民医院收治的冠状动脉疾病患者180例为研究对象,均行非体外循环冠状动脉旁路移植术,依据麻醉后方法分为观察组和对照组各90例。观察组患者在常规麻醉诱导基础上先行依据患者体重注射1μg/kg的盐酸右美托咪定,遂采用间隔15 min的0.5μg/(kg·h)的微泵输注方式直至手术结束,对照组患者给予同等的麻醉诱导后给予氯化钠注射液。观察两组患者进入手术室、血管吻合完毕、术后6 h、12 h、24 h时间节点的缺血修饰白蛋白(IMA)、心肌肌钙蛋白(cTnI),同时比较两组患者术前、插管后、劈开胸骨时、术后和术后24 h的血流动力学相关指标水平。结果IMA层面,术前及术后24 h观察点比较,差异无统计学意义(P>0.05),其余观察点显示观察组患者IMA水平均低于对照组患者,差异具有统计学意义(P<0.05);cTnI层面,除术前观察点外,其余时间各观察点显示观察组患者cTnI水平均低于对照组(P<0.05);血流动力学方面,两组患者平均动脉压术后均低于术前(P<0.05);心率层面,插管后及劈开胸骨时观察点均低于术前,术后和术后24 h观察点高于术前(P<0.05);组间比较,每一观察时间点观察组患者血流动力学相关指标均低于对照组(P<0.05)。结论右美托咪定能够有效改善患者血流动力学水平,维持其稳定并缓解治疗过程中对患者心肌损伤。

Objective To investigate the application of dexmedetomidine in off-pump coronary artery bypass grafting and its protective effect on myocardium.Methods A total of 180 patients with coronary artery disease admitted to the Seventh People's Hospital of Zhengzhou from January 2023 to June 2023 were selected as the study objects,all of whom underwent off-pump coronary artery bypass grafting,and were divided into the observation group and the control group,90 patients in each group according to the method of anesthesia.On the basis of conventional anesthesia induction,patients in the observation group were first injected with dexmedetomidine hydrochloride of 1μg per kg of body weight according to the patient's body weight,then 0.5μg/(kg·h)micropump infusion at an interval of 15 min until the end of the operation,and patients in the control group were given sodium chloride injection after the same anesthesia induction.The ischemia-modified albumin(IMA)and cardiac troponin(cTnI)levels of patients in the two groups were observed after entering the operating room,after vascular anastomosis,and at 6 h,12 h,and 24 h after surgery.Meanwhile,the hemodynamic indexes of patients in the two groups were compared before,after intubation,at sternum splitting,after surgery,and 24 h after surgery.Results At the IMA level,there was no statistically significant difference between the observation points before and 24 h after surgery(P>0.05),and the other observation points showed that the IMA level in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).At the level of cTnI,except for the preoperative observation points,the cTnI level in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05);in terms of hemodynamics,the average arterial pressure of the two groups of patients was lower after surgery than before,and the difference was statistically significant(P<0.05);at the heart rate level,the observation points after intubation and at splitting sternum were lower than before surgery,and the observation points after surgery and 24 hours after surgery were higher than before surgery(P<0.05).Compared between groups,the relevant indexes of hemodynamics in the observation group were lower than those in the control group at each observation time point(P<0.05).Conclusion Dexmetomidine can effectively improve patient hemodynamic levels,maintain stability,and alleviate myocardial damage during treatment.