右美托咪定對(duì)體外循環(huán)術(shù)后患者的心臟保護(hù)作用的研究

朱金偉 劉聰 劉忠民 袁林

摘要：目的? 探討右美托咪定對(duì)ICU中體外循環(huán)心臟術(shù)后患者的心肌保護(hù)作用。方法? 收集我院2014年9月～2018年8月ICU收治的體外循環(huán)心臟術(shù)后患者107例，隨機(jī)分為實(shí)驗(yàn)組（54例）及對(duì)照組（53例）。對(duì)照組患者使用咪達(dá)唑侖或丙泊酚鎮(zhèn)靜，實(shí)驗(yàn)組患者給予右美托咪定鎮(zhèn)靜。記錄兩組患者手術(shù)時(shí)間、體外循環(huán)時(shí)間及術(shù)后ICU停留時(shí)間等手術(shù)相關(guān)資料;比較兩組術(shù)后1、24、48 h血壓、心率（HR）、肌鈣蛋白Ⅰ（cTnⅠ）、心肌肌酸激酶同工酶（CK-MB）、腦鈉肽（NT-BNP）、中心靜脈壓（CVP）及左心射血分?jǐn)?shù)（EF）。結(jié)果? 實(shí)驗(yàn)組患者術(shù)后ICU停留時(shí)間短于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;術(shù)后24、48 h實(shí)驗(yàn)組cTnⅠ、CK-MB水平低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;離開(kāi)ICU時(shí)實(shí)驗(yàn)組MAP為（77.82±1.87）mmHg，對(duì)照組MAP為（82.64±1.69）mmHg，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;實(shí)驗(yàn)組術(shù)后心律失常發(fā)生率低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論①心臟手術(shù)后使用右美托咪定通過(guò)心肌保護(hù)作用，可以一定程度上改善預(yù)后;②本研究不支持右美托咪定致竇性心動(dòng)過(guò)緩發(fā)生率增加，同時(shí)右美托咪定可以減少心律失常發(fā)生率;③體外循環(huán)心臟手術(shù)患者應(yīng)用右美托咪定鎮(zhèn)靜，需警惕臨床中低血壓風(fēng)險(xiǎn)。

關(guān)鍵詞：重癥監(jiān)護(hù)病房;右美托咪定;體外循環(huán);心肌保護(hù)

中圖分類(lèi)號(hào)：R614? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻(xiàn)標(biāo)識(shí)碼：A? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2019.08.002

文章編號(hào)：1006-1959（2019）08-0004-04

Abstract：Objective? To investigate the myocardial protective effect of dexmedetomidine on patients with cardiopulmonary bypass after ICU.Methods? ?A total of 107 patients with cardiopulmonary bypass who underwent ICU admitted to our hospital from September 2014 to August 2018 were randomly divided into experimental group （54 cases） and control group （53 cases）. Patients in the control group were sedated with midazolam or propofol， and patients in the experimental group were given dexmedetomidine sedation. Surgical data such as operation time， cardiopulmonary bypass time and postoperative ICU stay time were recorded. The blood pressure， heart rate （HR）， troponin I （cTnI） and cardiac creatine were compared at 1， 24 and 48 h after operation. Kinase isoenzyme （CK-MB）， brain natriuretic peptide （NT-BNP）， central venous pressure （CVP）， and left ventricular ejection fraction （EF）.Results? The ICU stay in the experimental group was shorter than that in the control group，the difference was statistically significant （P<0.05）. The levels of cTnI and CK-MB in the experimental group were lower than those in the control group at 24 and 48 hours after operation，the difference was statistically significant （P<0.05）. The MAP of the experimental group was （77.82±1.87） mmHg when leaving the ICU， and the MAP of the control group was （82.64±1.69） mmHg，the difference was statistically significant （P<0.05）. The incidence of posterior arrhythmia was lower than that of the control group，the difference was statistically significant （P<0.05）.Conclusion? ①The use of dexmedetomidine after cardiac surgery can improve the prognosis to some extent through myocardial protection;②This study does not support the increase in the incidence of sinus bradycardia caused by dexmedetomidine， while dexmedetomidine can Reduce the incidence of arrhythmia; ③Patients with cardiopulmonary bypass surgery with dexmedetomidine sedation， need to be alert to the risk of clinical hypotension.