网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
右美托咪定对单肺通气老年患者围术期心肌损伤的影响
作者:王喆妍1  臧婷1  骆璇2  马正良1 
单位:1. 南京大学医学院附属南京鼓楼医院 麻醉科, 江苏 南京 210008;
2. 南京大学医学院附属南京鼓楼医院 心胸外科, 江苏 南京 210008
关键词:右美托咪定 单肺通气 心肌保护 
分类号:R614.2
出版年·卷·期(页码):2018·46·第七期(751-754)
摘要:

目的:研究右美托咪定(DEX)对单肺通气(OLV)老年患者围术期心肌损伤的影响。方法:选择行食管癌根治术的老年患者60例(ASA Ⅰ~Ⅱ级),采用随机数字表法分组:试验组(n=30)诱导前静脉泵入DEX 1.0 μg·kg-1,10 min注射完毕,诱导后静脉泵入DEX 0.6 μg·kg-1·h-1,直至手术结束;对照组(n=30)等速等容量静脉泵入生理盐水。所有病例采用全身麻醉,术中双腔气管插管单肺通气。分别于诱导前(T0)、单肺通气30 min (T1)、术毕(T2)、术后24 h (T3)取血测定脑尿钠肽(BNP)、肌钙蛋白(cTnT)水平;记录入室时(T0')、插双腔气管导管时(T4)、切皮时(T5)、插单腔气管导管(T6)时平均动脉压(MAP)和心率(HR)。结果:两组BNP、cTnT、MAP、HR在T0、T0'时差异均无统计学意义(P>0.05)。与T0相比,在T2、T3时两组BNP和cTnT水平均明显升高(均P<0.01),但试验组BNP和cTnT水平明显低于对照组(均P<0.05)。与T0'相比,T4、T5、T6时试验组的MAP、HR变化均不明显(均P>0.05),但明显低于对照组(均P<0.05)。结论:单肺通气的老年患者术中应用DEX能明显减轻围术期心肌损伤,改善患者围术期的血流动力学。

Objective:To study the effects of dexmedetomidine(DEX) on perioperative myocardial injury in elderly patients with single lung ventilation(OLV). Methods: Sixty elderly patients with esophageal cancer radical (ASA Ⅰ-Ⅱ) were enrolled in this study. The patients were divided into two groups by random number method. The test group (n=30) were induced using DEX 1.0 μg·kg-1,and the injection was completed in 10 min. After induction,they were received the DEX 0.6 μg·kg-1·h-1 until the end of the operation. The control group(n=30) were received the normal volume of saline.Systemic anesthesia was used in all cases,and bilateral endotracheal intubation was performed. At the time point of the before induction(T0),OLV for 30 min(T1), the end of operation(T2), 24 h after surgery(T3),brain natriuretic peptide(BNP) and troponin (cTnT)were detected. The mean arterial pressure(MAP) and heart rate(HR)were recorded at the time of entering the operating room(T0'), inserting thedouble lumen endotracheal tube(T4),cutting skin(T5) and inserting the single lumen endotracheal tube(T6).Results: The differences of BNP, cTnT, MAP, HR between the two groups at T0 or T0'had no statistical significance (P>0.05). Compared with T0, BNP and cTnT of the two groupswere significantly higher at T2 and T3 (all P<0.01), butthe BNP and cTnT of the test group were significantly lower than those of the control group(all P<0.05).Compared with T0', the changes of MAP and HR at T4, T5 and T6 of the test group were not obvious (all P>0.05), butthe MAP and HR of the test groupwere significantly lower than those of the control group (all P<0.05).Conclusion: The application of DEX can significantly reduce perioperative myocardial injury and improve perioperative hemodynamics in elderly patients with single lung ventilation.

参考文献:

[1] RAHAGHI F N,LAZEA D,DIHYA S,et al.Preoperative pulmonary vascular morphology and its relationship to postpneumonectomy hemodynamics[J].Acad Radiol,2014,21(6):704-710.
[2] DEVEREAUX P J,BICCARD B M,SIGAMANI A,et al.Association of postoperative high-sensitivity troponin levels with myocardial injury and 30-day mortality among patients undergoing noncardiac surgery[J].JAMA,2017,317(16):1642-1651.
[3] DEVEREAUX P J,CHAN M T,ALONSO-COELLO P,et al.Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery[J].JAMA,2012,307(21):2295-2304.
[4] GANJOO P,PANDEY V K,SINGH H,et al.Unusual perioperative cardiac emergency in a healthy young woman[J].Case Rep Anesthesiol,2012,2012:103051.
[5] KHAN J,ALONSO-COELLO P,DEVEREAUX P J,et al.Myocardial injury after noncardiac surgery[J].Curr Opin Cardiol,2014,29(4):307-311.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 238573 位访问者


 ©《现代医学》编辑部
联系电话:025-83272479;83272481
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541