摘要
目的探讨七氟醚复合右美托咪定对全麻行心脏瓣膜置换术2型糖尿病(T2DM)患者应激、循环系统和心肌损伤标志物的影响。方法前瞻性随机选取2022年3月至2023年3月于河南大学第一附属医院接受心脏瓣膜置换术的60例T2DM患者,根据信封法将其随机划分为试验组和对照组,各30例。试验组在手术开始时接受持续泵注右美托咪定0.5μg·kg^(-1)·h^(-1)直至手术结束,并于主动脉开放时通过体外循环(CPB)机给予体积分数2%的七氟醚15 min;对照组泵入等体积9 g·L^(-1)氯化钠注射液,给予相同七氟醚麻醉方案。比较两组患者围手术期指标、应激反应指标、血流动力学指标及心肌损伤标志物。结果两组患者CPB时间、手术时间、胰岛素使用情况及术中平均血糖水平差异无统计学意义(P>0.05);术后试验组血糖(Glu)、皮质醇(Cor)及肾上腺素(E)水平低于对照组(P<0.05);两组患者心率(HR)、平均动脉压(MAP)组间、时间及交互效应有统计学意义(P<0.05);术后试验组肌钙蛋白I(cTnI)、肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)水平低于对照组(P<0.05)。结论在T2DM患者心脏瓣膜置换术中使用七氟醚复合右美托咪定麻醉,可有效减轻应激反应和心肌损伤,维持血流动力学稳定。
Objective To investigate the effect of sevoflurane combined with dexmedetomidine on stress,circulatory system and myocardial injury markers in patients with type 2 diabetes mellitus(T2DM)undergoing heart valve replacement under general anesthesia.Methods A prospective randomized controlled study was conducted.A total of 60 patients with T2DM who underwent heart valve replacement at the the First Affiliated Hospital of Henan University from March 2022 to March 2023 were selected.They were randomly divided into treatment group and control group by the envelope method,with 30 patients in each group.The treatment group was given continuous infusion of dexmedetomidine at 0.5μg·kg^(-1)·h^(-1)at the beginning of operation till the end of operation,and was treated with 2%volume fraction sevoflurane for 15 minutes by cardiopulmonary bypass(CPB)machine when the aorta was open.The control group was injected with equal volume of 9 g·L^(-1)sodium chloride injection,and given the same sevoflurane anesthesia.Perioperative indicators,stress response indicators,hemodynamic indicators,and myocardial injury markers were compared between the two groups.Results There was no statistically difference between the two groups in terms of CPB time,operation time,insulin use,and intraoperative average blood glucose level(P>0.05).After operation,the levels of blood glucose(Glu),cortisol(Cor)and epinephrine(E)in the treatment group were significantly lower than those in the control group(P<0.05).There were statistically differences in heart rate(HR)and mean arterial pressure(MAP)in terms of time effect,inter-group effect and interaction effect(P<0.05).After operation,the levels of troponin I(cTnI),creatine kinase(CK)and creatine kinase isozyme(CK-MB)in the treatment group were significantly lower than those in the control group(P<0.05).Conclusion Applying sevoflurane combined with dexmedetomidine anesthesia to patients with T2DM undergoing heart valve replacement can effectively reduce stress response and myocardial injury,and maintain hemodynamic stability.
作者
毛珊珊
张晗
李萌
庞红利
陈勇
MAO Shanshan;ZHANG Han;LI Meng;PANG Hongli;CHEN Yong(Department of Anesthesia and Perioperative Medicine,the First Affiliated Hospital of Henan University,Kaifeng 475000,China)
出处
《河南医学研究》
CAS
2024年第23期4309-4313,共5页
Henan Medical Research
基金
开封市科技发展计划项目(2203025)
河南省二○二二年科技发展计划项目(222102310576)。
作者简介
通信作者:毛珊珊,E-mail:18436326264@163.com。
