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。方法筛选2015年1月~2018年6月在三家医院进行心脏瓣膜置换手术的患者72例。按照数字表法随机分为对照组和治疗组,每组36例。方法两组均予麻醉前吗啡10mg肌肉注射,治疗组入室后给予右美托咪定0.5μg/(kg·h)微量泵静脉注入,泵注10min,随后以0.5μg/(kg·h)维持直至手术结束。对照组予生理盐水输注。两组诱导方式:咪唑安定5mg、罗库溴铵1mg/kg、舒芬太尼1.0μg/kg、依托咪酯0.1~0.2mg/kg,术中维持予丙泊酚3~8mg/(kg·h)静滴、1.5%~2.5%浓度七氟烷吸入,并予罗库溴铵和舒芬太尼间断追加。手术均行正中胸骨切口,建立体外循环后,采用浅低温(28℃~30℃),常规流量灌注,维持血液稀释(血红细胞压积20%~25%),心肌保护采用4份冷血∶1份晶体高钾停跳液行冠状动脉灌注。治疗后比较两组患者术前(T0)、插管后(T1)、切皮时(T2)、劈胸骨时(T3)、CPB前(T4)、CPB停机10min后(T5)的MAP、HR变化情况,及CPB前(T4)、CPB停机24h后(T6)CK-MB、cTnI的变化情况。同时记录两组患者升主动脉阻断时间,体外循环时间,升主动脉开放后心脏复跳情况,最低鼻咽温。结果两组主动脉阻断时间、体外循环时间、升主动脉开放后自动复跳例数、最低鼻咽温比较,差异无统计学意义(P>0.05),治疗组T1~5时点MAP水平显著低于T0,与对照组比较,T1~4时点MAP水平显著低于对照组,差异具有显著性(P<0.05)。治疗组T1~4时点HR水平显著低于T0,与对照组比较,治疗组T1~4时点HR水平显著低于对照组,差异具有显著性(P<0.05)。治疗组和对照组CPB前的CK-MB、cTnI含量比较,差异无显著性(P>0.05)。CPB停机后24h,两组患者的CK-MB、cTnI水平较CPB前比较显著提高,且治疗组患者的CK-MB、cTnI水平显著低于对照组,差异具有显著性(P<0.05)。结论在心脏瓣膜置换手术麻醉中予以右美托咪定联合舒芬太尼对心肌具有一定保护作用。
Objective To discuss the myocardial protective effect of dexmedetomidine combined with sufentanil in anesthesia of heart valve replacement surgery.Methods A total of 72 patients receiving heart valve replacement surgery from January 2015 to June 2018 were selected.According to the digital table method,they were randomly divided into the control group and the treatment group,with 36 cases in each group.Both groups were given intramuscular injection of morphine 10 mg before anesthesia.The treatment group was given dexmedetomidine 0.5μg/(kg·h)microinjection intravenously,pumped for 10 min,and then maintained at 0.5μg/(kg·h)until the end of the operation.The control group was given saline infusion.The two groups were induced by midazolam 5 mg,rocuronium 1 mg/kg,sufentanil 1.0μg/kg,and etomidate 0.1-0.2 mg/kg,intraoperative maintenance by propofol 3-8 mg/(kg·h)intravenous infusion,1.5%-2.5%sevoflurane inhalation,and discontinuously addition of rocuronium and sufentanil.All the operations were performed by the middle of the sternal incision.After the establishment of extracorporeal circulation,the patients were treated with mild hypothermia(28℃-30℃),routine flow perfusion,and maintenance of blood dilution(hemoerythrocytosis 20%-25%).Myocardial protection was performed with 4 cold blood:1 crystal high potassium cardioplegic solution for coronary perfusion.Changes in MAP,HR before operation(T0),post-intubation(T1),at incision of skin(T2),at splitting of sternum(T3),before CPB(T4),and 10 minutes after CPB(T5)and the changes in CK-MB,cTnI before CPB(T4),24 h after CPB(T6)were compared between the two groups.At the same time,the clamping time of ascending aorta,the time of extracorporeal circulation,the heart resuscitation after declamping of ascending aorta,and the lowest nasopharyngeal temperature of patients in both groups were recorded.Results There were no significant differences in the clamping time of ascending aorta,the time of extracorporeal circulation,the heart resuscitation cases after declamping of ascending aorta,and the lowest nasopharyngeal temperature between the two groups(P>0.05).The MAP levels at T1-5 were significantly lower than that at T0 in the treatment group,and when compared with the control group,the MAP levels at T1-4 were significantly lower than those of the control group,and the differences were significant(P<0.05).The HR levels at T1-4 was significantly lower than that at T0 in the treatment group,and when compared with the control group,the HR levels at T1-4 in the treatment group was significantly lower than those in the control group(P<0.05).There was no significant difference in the levels of CK-MB and cTnI before CPB between the two groups(P>0.05).At 24 hours after CPB shutdown,the levels of CK-MB and cTnI in the two groups were significantly higher than those before CPB,and the levels of CK-MB and cTnI in the treatment group were significantly lower than those in the control group(P<0.05).Conclusion Dexmedetomidine combined with sufentanil has a protective effect on myocardium during anesthesia of heart valve replacement surgery.
作者
倪云建
吴城
周红梅
徐传华
邱灿金
NI Yunjian;WU Cheng;ZHOU Hongmei;XU Chuanhua;QIU Canjin(Department of Anesthesiology,the Second Hospital of Jiaxing in Zhejiang Province,Jiaxing 314000,China;Department of Anesthesiology and Pain,Taizhou Hospital in Zhejiang Province,Taizhou 318000,China;Department of Anesthesiology,Jiaxing Hospital of Armed Police Zhejiang Hospital,Jiaxing 314000,China)
出处
《中国现代医生》
2019年第14期112-115,共4页
China Modern Doctor
基金
浙江省医药卫生一般项目(2015KYB388)
