摘要
目的评价右美托咪定对合并肺动脉高压患者二尖瓣置换术时血流动力学和心肌损伤的影响。方法择期行二尖瓣置换术的肺动脉高压患者40例，年龄18～64岁，性别不限，体重45-75kg，ASA分级Ⅱ或Ⅲ级。采用随机数字表法，将其分为2组（n=20）：对照组（C组）和右美托咪定组（D组）。气管插管后D组经10min静脉注射右美托咪定负荷量1μg／kg，随后以0．5μg·kg^-1·h^-1速率输注至术毕，c组输注等容量生理盐水。麻醉诱导后气管插管，机械通气，采用静吸复合麻醉，维持Narcotrend指数值40～50。分别于给予右美托咪定前即刻、停CPB后10min、术毕、术后6、24h时采集中心静脉血样，测定血浆CK．MB和cTnI的水平。于右美托咪定给药前后、切皮时、劈胸骨时、CPB前后及手术结束时，采用Swan—Ganz导管及VigilanceII血液动力学监测系统测定HR、MAP、肺动脉平均压（MPAP）、心排量（CO）、外周循环阻力（SVR）、肺循环阻力（PVR）。记录术中血管活性药物应用情况和心脏自动复跳情况。结果D组各血流动力学指标在切皮、劈胸骨手术刺激时维持稳定，CPB后MPAP下降并维持在较低水平。与c组比较，D组血浆CK—MB及cTnI水平、术中去氧肾上腺素用量、多巴胺用量及肾上腺素使用率降低（P〈0．05），米力农用量和心脏自动复跳率差异无统计学意义（P〉0．05）。结论合并肺动脉高压患者二尖瓣置换术中，静脉注射右美托咪定负荷量1μg／kg，随后以0．5μg·kg^-1·h^-1速率输注右美托眯定，有助于维持体循环和肺循环的稳定，且产生一定程度的心肌保护作用。
Objective To investigate the effects of dexmedetomdine on hemodynamics and myocardial injury in patients with pulmonary hypertension undergoing mitral valve replacement. Methods Forty ASA II or m patients with pulmonary hypertension, aged 18-64 yr, undergoing mitral valve replacement, were randomized into 2 groups （ n = 20 each） ： control group （group C） and dexmedetomidine group （group D）. Anesthesia was induced with iv midazolam 0.05 mg/kg, sufentanil 1 ttg/kg, etomidate O. 3 mg/kg and rocuronium O. 6 mg/kg and main- mined with combined intravenous-inhalational anesthesia. Narcotrend index values were maintained at 40-50. The patients were tracheal intubated and mechanically ventilated. A loading dose of dexmedetomidine 1μg/kg was injected intravenously over 10 min after intubation followed by infusion at 0.5 μg·kg^-1·h^-1 until the end of operation in group D. While the equal volume of normal saline was given in group C. Venous blood samples were taken im- mediately before dexmedetomidine administration, at 10 min after termination of cardiopulmonary bypass （CPB）, at the end of operation, and at 6 and 24 h after operation for determination of plasma levels of creatine kinase MB （CK-MB） and cardiac troponin I （cTnI） by ELISA. Before and after administration of dexmedetomidine, at skin incision, at sternum splitting, before and after CPB, and at the end of operation, HR, MAP, mean pulmonary ar- terial pressure （MPAP）, cardiac output （CO）, systemic vascular resistance （SVR） and pulmonary vascular resis- tance （PVR） were detected by using Swan-Ganz catheter and Vigilance 1I monitor. The requirement for vasoactive drugs and condition of spontaneous heart beats were recorded. Results In group D, each hemodynamic parameter was maintained stable at skin incision and sternum splitting, and MPAP was decreased after CPB and maintained at a lower level. The plasma levels of CK-MB and cTnI, consumption of phenylephrine and dopamine, and requirement for epinephrine were significantly lower in group D than in group C （P 〈 0.05）. There was no significant difference in the consumption of milrinone and rate of spontaneous heart beat between the two groups （ P 〉 0.05 ）. Conclusion During mitral valve replacement for patients with pulmonary hypertension, dexmedetomidine infused at 0.05 μg·kg^-1·h^-1 after a loading dose of 1 μg/kg is helpful in maintaining systemic circulation and pulmonary circulation stable and provides myocardial protection to some extent.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2013年第5期537-540,共4页
Chinese Journal of Anesthesiology
基金
河南省自然科学基金（122300410068）
关键词
右美托咪啶
血流动力学
心脏瓣膜假体植入
心肌损伤
Dexmedetomidine
Hemodynamics
Heart valve prosthesis implantation
Myocardial injury
作者简介
通信作者：孟凡民，Email：mfmsy@tom．com
