右美托咪定對體外循環術后患者的心臟保護作用的研究

朱金偉 劉聰 劉忠民 袁林

摘要：目的? 探討右美托咪定對ICU中體外循環心臟術后患者的心肌保護作用。方法? 收集我院2014年9月～2018年8月ICU收治的體外循環心臟術后患者107例，隨機分為實驗組（54例）及對照組（53例）。對照組患者使用咪達唑侖或丙泊酚鎮靜，實驗組患者給予右美托咪定鎮靜。記錄兩組患者手術時間、體外循環時間及術后ICU停留時間等手術相關資料;比較兩組術后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）及左心射血分數（EF）。結果? 實驗組患者術后ICU停留時間短于對照組，差異有統計學意義（P<0.05）;術后24、48 h實驗組cTnⅠ、CK-MB水平低于對照組，差異有統計學意義（P<0.05）;離開ICU時實驗組MAP為（77.82±1.87）mmHg，對照組MAP為（82.64±1.69）mmHg，差異有統計學意義（P<0.05）;實驗組術后心律失常發生率低于對照組，差異有統計學意義（P<0.05）。結論①心臟手術后使用右美托咪定通過心肌保護作用，可以一定程度上改善預后;②本研究不支持右美托咪定致竇性心動過緩發生率增加，同時右美托咪定可以減少心律失常發生率;③體外循環心臟手術患者應用右美托咪定鎮靜，需警惕臨床中低血壓風險。

關鍵詞：重癥監護病房;右美托咪定;體外循環;心肌保護

中圖分類號：R614? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻標識碼：A? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2019.08.002

文章編號：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.