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中国应用生理学杂志 ›› 2016, Vol. 32 ›› Issue (5): 459-462.doi: 10.13459/j.cnki.cjap.2016.05.019

• 研究论文 • 上一篇    下一篇

右美托咪定对高血压心肌肥厚患者围术期心肌的保护作用

武勇1, 张小宝1, 钱燕宁2, 肖杭3   

  1. 1. 南京医科大学连云港临床医学院麻醉科, 江苏连云港 222002;
    2. 南京医科大学第一附属医院麻醉科, 江苏南京 210029;
    3. 南京医科大学公共卫生学院, 江苏南京 210029
  • 收稿日期:2016-04-11 修回日期:2016-07-06 出版日期:2016-09-28 发布日期:2018-06-20
  • 通讯作者: 肖杭,Tel:025-86860409;E-mail:hxiao@njmu.edu.cn E-mail:hxiao@njmu.edu.cn
  • 基金资助:
    江苏省青年基金资助(BK20160423);连云港市科技局课题资助(SH1402)

The protective effects of dexmedetomidine on perioperative myocardial injury in patients with hypertensive myocardial hypertrophy

WU Yong1, ZHANG Xiao-bao1, QIAN Yan-ning2, XIAO Hang3   

  1. 1. Department of Anesthesiology, Lianyungang Clinical Medical College of Nanjing Medical University, Lianyungang 222002;
    2. Department of Anesthesiology, TheFirst Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China;
    3. Department of Toxicology, School of Public Health, Nanjing Medical University, Nanjing 210029, China
  • Received:2016-04-11 Revised:2016-07-06 Online:2016-09-28 Published:2018-06-20
  • Supported by:
    江苏省青年基金资助(BK20160423);连云港市科技局课题资助(SH1402)

摘要: 目的:观察右美托咪定(DEX)对高血压心肌肥厚患者心肌的保护作用。方法:将符合诊断标准54例患者随机分为两组(n=27):DEX组(D组)和对照组(C组)。D组于麻醉诱导前15 min给予负荷剂量右美托咪定1 μg/kg,静脉泵注10 min,随后维持剂量0.5 μg/(kg·h)至手术结束。C组相应时间泵注等量生理盐水。两组患者麻醉前2 h连接Holter记录仪,静息平卧连续记录1 h作为基础值,其后连续记录24 h。并在T0(诱导前)、T1(手术开始1 h)、T2(术后4 h)、T3(术后12 h)、T4(术后24 h)五个时间点采集血样测定缺血修饰白蛋白(IMA)和血清肌钙蛋白I(cTnI)。观察并记录两组患者手术时间、出血量和心血管并发症等临床指标。结果:D组在T1、T2、T3时IMA水平均明显低于C组(P<0.05),在T1、T2、T3、T4时cTnI水平均明显低于C组(P<0.05),Holter显示D组ST段缺血样改变和复杂室性心律失常明显低于C组(P<0.05)。结论:DEX可以减轻高血压心肌肥厚患者围术期心肌损伤,减少ST段缺血样改变和复杂室性心律失常的发生率,具有一定的心肌保护作用。

关键词: 右美托咪定, 高血压, 心肌肥厚, 心肌保护

Abstract: Objective: The purpose of this study was to evaluate the effects of dexmedetomidine (DEX) on patients with hypertensive myocardial hypertrophy.Methods: Fifty four patients with hypertensive myocardial hypertrophy were enrolled in the study and were randomly divided into two groups (n=27). Patients in groupD were pretreated with DEX (1 μg/kg) before induction and then maintain with 0.5 μg/(kg·h) DEX. Patients in group C were pretreated with saline at the same time. All patients were connected with holter recorder 2 h before anesthesia and were continuously recorded for 24 h. Blood sample were collected to measure ischemia modified albumin(IMA) and serum cardiac troponin I (cTnI) at the time of T0 (before induction), T1(1 h after surgery), T2(4 h after surgery), T3(12 h after surgery) and T4(24 h after surgery). The surgery time, blood loss and side effect of two groups were recorded at the same time.Results: The serum IMA level in group D was lower than that of group C at the time of T1, T2 and T3 (P<0.05). The serum cTnI in group C was higher than that of group D at the time of T1, T2, T3 and T4 (P<0.05). Changes of ST and complicated ventricular arrhythmias ingroup D were lower than those of group C (P<0.05).Conclusion: DEX could reduce the incidence of myocardial damage, changes of ST and complicated ventricular arrhythmias in patients with hypertensive myocardial hypertrophy.

Key words: dexmedetomidine, hypertension, myocardial hypertrophy, myocardial protection

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