摘要
目的探讨右美托咪定联合舒芬太尼在心脏瓣膜置换手术麻醉中对心肌的保护作用及血流动力学的影响。方法选取湖南中医药高等专科学校附属第一医院2019年1月至2020年6月行心脏瓣膜置换术的患者86例,按随机数字表法分为观察组和对照组,各43例。观察组患者麻醉诱导前以0.5μg/(kg·h)右美托咪定和等量0.9%氯化钠注射液微量泵静脉泵注至术毕,对照组患者以等量0.9%氯化钠注射液微量泵静脉泵注至术毕,两组患者麻醉诱导及麻醉维持全程均应用舒芬太尼[0.5~1.0μg/kg,0.5~1.0μg/(kg·h)]镇痛,比较两组患者的手术情况,麻醉和镇静效果,不同时间点[术前(T_(0))、插管后(T_(1))、切皮时(T_(2))、劈胸骨时(T_(3))、体外循环前(T_(4))、体外循环停机10 min后(T_(5))]的血流动力学指标[心率、平均动脉压(MAP)]变化,术后心肌损伤指标[肌钙蛋白I(c TnI)、肌酸激酶MB型同工酶(CK-MB)、心型脂肪酸结合蛋白(HFABP)]水平变化,以及不良反应。结果两组患者主动脉隔断、体外循环、手术时间及术中出血量比较,差异均无统计学意义(P>0.05);观察组患者舒芬太尼和丙泊酚用量、拔管5 min后躁动评分、术后拔管时Ramsay评分均显著低于对照组(P<0.05);两组患者T_(1)~T_(5)的MAP均显著低于T_(0)(P<0.05),T_(1)~T_(4)的心率均显著低于T_(0)(P<0.05),且观察组患者T_(1)~T_(4)的MAP和心率均显著低于对照组(P<0.05);两组患者术后24,48,72 h的c TnI,CK-MB,HFABP水平均显著高于术前(P<0.05),且观察组均显著低于对照组(P<0.05);观察组患者术后48 h内的高血压、心律失常、恶心呕吐及术后3 d谵妄发生率均显著低于对照组(P<0.05)。结论心脏瓣膜置换术麻醉中联用右美托咪定与舒芬太尼,可减少麻醉药物用量,维持患者血流动力学稳定,减轻心肌损伤及术后谵妄。
Objective To investigate the effect of dexmedetomidine combined with sufentanil on myocardial protection and hemodynamics during anesthesia for patients undergoing heart valve replacement.Methods A total of 86 patients scheduled for heart valve replacement in the First Affiliated Hospital of Hunan College of Traditional Chinese Medicine from January 2019 to June 2020 were selected and divided into the observation group and the control group according to the random number table method,43 cases in each group.The patients in the observation group received micropump intravenous injection of 0.5μg/(kg·h)dexmedetomidine and an equal velume of 0.9%Sodium Chloride Injection before anesthesia induction until the end of the surgery,while the patients in the control group received micropump intravenous injection of an equal velume of 0.9%Sodium Chloride Injection before anesthesia induction until the end of the surgery,and the patients in the two groups were given sufentanil[0.5-1μg/kg and 0.5-1.0μg/(kg·h)]for analgesia during anesthesia induction and anesthesia maintenance.The surgical conditions,anesthesia and sedation effects,hemodynamic indicators[heart rate(HR),mean arterial pressure(MAP)]at different time points[before surgery(T_(0)),after intubation(T_(1)),during skin incision(T_(2)),at sternum splitting(T_(3)),before cardiopulmonary bypass(CPB,T_(4)),at 10 min after CPB stop(T_(5))]and myocardial injury indicators[troponin I(c TnI),creatine kinase(CK-MB),heart fatty acid-binding protein(HFABP)]after the surgery and adverse reactions were compared between the two groups.Results There were no significant differences in the aortic block time,CPB time,surgical time,and intraoperative blood loss between the two groups(P>0.05).The dosage of sufentanil and propofol,agitation score at 5 min after extubation,and Ramsay score after postoperative extubation in the observation group were significantly lower than those in the control group(P<0.05).The MAP level at T_(1)-T_(5)in the two groups was significantly lower than that at T_(0),and the HR level at T_(1)-T_(4)was significantly lower than that at T_(0)(P<0.05),the MAP level and HR level at T_(1)-T_(4)in the observation group were significantly lower than those in the control group(P<0.05).At 24,48,72 h after the surgery,the levels of c TnI,CK-MB and HFABP in the two groups were significantly higher than those before the surgery(P<0.05),and those in the observation group were significantly lower than those in the control group(P<0.05).The incidence rates of hypertension,arrhythmia and nausea and vomiting within 48 h after surgery and delirium on the third day after surgery in the observation group were significantly lower than those in the control group(P<0.05).Conclusion Dexmedetomidine combined with sufentanil can effectively reduce the dosages of anesthetic drugs during the anesthesia for patients undergoing heart valve replacement,and it can maintain hemodynamic stability,reduce myocardial injury and postoperative delirium.
作者
吴鹏涛
魏来
WU Pengtao;WEI Lai(The First Affiliated Hospital of Hunan College of Traditional Chinese Medicine,Zhuzhou,Hunan,China 412000;Hunan Provincial People’s Hospital,Changsha,Hunan,China 410005)
出处
《中国药业》
CAS
2021年第17期46-49,共4页
China Pharmaceuticals
基金
湖南省自然科学基金[2018JJ2331]。
