摘要
目的探讨右美托咪定(DEX)联合氯胺酮(KET)对冠心病非心脏手术患者围手术期心肌保护作用的影响。方法选取2018年7月至2018年10月收治的拟行腔镜下腹部手术治疗的合并冠心病患者40例,按随机数字表法分为DK组(输注DEX和KET)和D组(输注DEX),每组20例。2组患者均给予常规治疗,DK组麻醉采用输注DEX和KET,D组麻醉采用DEX。分别在麻醉前(T0)、术毕(T1)、术后24 h(T2)测定2组患者的心肌损伤标志物含量(CK-MB、cTnⅠ),观察2组患者心肌保护效果及不良反应发生情况。结果2组患者麻醉前(T0)心肌损伤标志物含量(CK-MB、cTnⅠ)差异无统计学意义(P>0.05)。术后2组患者组内比较,术毕(T1)、术后24 h(T2)的CK-MB、cTnⅠ均高于术前(T0),且随着时间,T2时的上述指标低于T1时,差异均有统计学意义(P<0.05);组间比较,术后D组上述指标在T1和T2时均高于DK组,差异有统计学意义(P<0.05)。术后D组患者的不良反应发生率为60.0%(12/20)明显高于DK组的25.0%(5/20),差异有统计学意义(P<0.05)。结论DEX联合KET能更好改善冠心病非心脏手术患者围手术期的心肌功能,降低患者术后不良反应发生情况,使冠心病非心脏手术患者围手术期的安全性得到提升。
Objective To investigate the effects of dexmedetomidine(DEX)combined with ketamine(KET)on myocardial protection at perioperative period in patients with coronary heart disease(CHD)undergoing non-cardiac surgery.Methods Forty patients with CHD who were admitted and treated by laparoscopic abdominal surgery in our hospital from July 2018 to October 2018 were divided into DK group(DEX and KET infusion)and group D(DEX infusion only),with 20 cases in each groups.The patients in both groups were given conventional treatment,and the patients in DK group were anesthetized by the infusion of DEX and KET,however,the patients in group D were anesthetized by the infusion of DEX only.The myocardial injury markers(CK-MB,cTnI)were measured before anesthesia(T0),after operation(T1)and at 24 hours after operation(T2),respectively.The myocardial protective effects and the incidence rate of adverse reactions were observed and compared between the two groups.Results Before anesthesia(T0),there were no significant differences in the myocardial injury marker contents(CK-MB,cTnⅠ)between the two groups(P>0.05).The levels of CK-MB and cTnI at T1 and T2 in both groups were significantly higher than those at T0,and with the time going on,the indexes mentioned above at T2 were significantly lower than those at T1(P<0.05).Moreover the indexes mentioned above at T1 and T2 in group D were significantly higher than those in group DK(P<0.05).In addition the incidence rate of adverse reactions in group D after operation was 60%(12/20),which was significantly higher than that[25%(5/20)]in group DK(P<0.05).Conclusion The dexmedetomidine combined with ketamine can better improve the perioperative myocardial function of patients with CHD who undergo non-cardiac surgery,and can reduce the incidence rate of adverse reactions after surgery,and improve the perioperative safety.
作者
靳彦涛
徐莉莉
张岚
杨征
王英
许艳荣
宁庚
JIN Yantao;XU Lili;ZHANG Lan(Tanshan Worker’s Hospital, Hebei, Tangshan 063000,China;不详)
出处
《河北医药》
CAS
2020年第12期1883-1885,共3页
Hebei Medical Journal
基金
河北省医学科学研究重点课题计划项目(编号:20191561)。
关键词
右美托咪定
氯胺酮
冠心病
非心脏手术
心肌保护
dexmedetomidine
ketamine
coronary heart disease
non-cardiac surgery
myocardial protection
