Study on the myocardial protective effect of dexmedetomidine whole course pump injection for cardiopulmonary bypass valve replacement
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摘要: 目的 观察右美托咪定全程泵注对体外循环下心脏瓣膜置换术患者的心肌保护作用。 方法 以2015年8月—2019年8月于义乌市中心医院进行体外循环下心脏瓣膜置换术的140例患者为研究对象,按随机数字表法分为研究组(70例)和对照组(70例)。所有患者均行体外循环瓣膜置换术,研究组予以右美托咪定全程泵注,对照组泵注等量生理盐水。统计麻醉诱导前(T0)、开放主动脉后(T1)、体外心肺分流结束时(T2)、术毕(T3)和术后24 h(T4)的心率(HR)、平均动脉压(MAP)和血氧饱和度(SPO2)等血流动力学参数,记录ICU停留时间和住院时间,观察患者心脏复跳情况,检测手术前后炎症因子及心肌损伤指标水平,观察术后心脏不良事件发生情况。 结果 研究组与对照组T0~T4时间点HR、MAP和SPO2差异均无统计学意义(均P>0.05);研究组患者ICU停留时间和住院时间与对照组比较差异均无统计学意义(均P>0.05),研究组患者心脏自动复跳率(92.86%)与对照组水平(87.14%)差异无统计学意义(χ2=1.270,P=0.260);研究组术后24 h血清炎症因子(TNF-α、IL-6和IL-8)和心肌损伤指标(CK-MB、cTnI和NT-proBNP)水平均显著低于对照组(均P<0.05);研究组患者术后30 d内心脏不良事件总体发生率(12.86%)显著低于对照组水平(32.86%),χ2=7.940,P=0.005。 结论 右美托咪定全程泵注可有效抑制体外循环瓣膜置换术后炎症反应,降低心肌损伤程度,减少心脏不良事件发生率。Abstract: Objective To observe the myocardial protective effect of dexmedetomidine whole course pump injection for cardiopulmonary bypass valve replacement. Methods Total 140 patients underwent cardiopulmonary bypass heart valve replacement in Yiwu central hospital from August 2015 to August 2019 were selected as the research object. All patients were divided into study group(n=70) and control group(n=70) according to random number table method. All patients underwent cardiopulmonary bypass valve replacement. The study group received dexmedetomidine whole course pump injection, and the control group received the same amount of normal saline. The hemodynamic parameters such as HR, MAP and SPO2 were recorded before anesthesia induction, after aortic opening, at the end of cardiopulmonary bypass, at the end of operation and 24 hours after operation were analyzed. The ICU stay time and hospitalization time were recorded. The cardiac rebound was observed. The levels of inflammatory factors and myocardial injury indexes were detected before and after the operation. The occurrence of adverse cardiac events was observed. Results There was no significant difference in HR, MAP and SPO2 between the two groups(all P>0.05). There was no significant difference in ICU stay time and hospitalization time between the two groups(all P>0.05). There was no significant difference in the rate of automatic cardiac rebound between the study group(92.86%) and the control group(87.14%, χ2=1.270, P=0.260). The levels of serum inflammatory factors(TNF-α, IL-6 and IL-8) and myocardial injury indexes(CK-MB, cTnI and NT-proBNP) in the study group were significantly lower than those in the control group(all P<0.05). The overall incidence of adverse cardiac events in the study group within 30 days(12.86%) was significantly lower than that in the control group(32.86%, χ2=7.940, P=0.005). Conclusion Dexmedetomidine whole pump injection can effectively inhibit the inflammatory response, reduce the degree of myocardial injury and the incidence of adverse cardiac events.
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