安徽医科大学学报2017，Vol.52Issue(6)：859-863,5.DOI:10.19405/j.cnki.issn1000-1492.2017.06.018
右美托咪定预处理对瓣膜置换术患者缺血后心肌的影响
Effect of dexmedetomidine preconditioning on ischemic myocardium in patients undergoing heart valve replacement surgery
摘要
Abstract
Objective To investigate the effect of dexmedetomidine preconditioning on myocardial ischemia-reperfusion injury(IRI) in patients undergoing mitral valve replacement under cardiopulmonary bypass(CPB).Methods Sixty patients,aged 18~65 years,scheduled for cardiac valve replacement under CPB were randomly divided into 2 groups(n=30 each).DEX group:0.6 mg/kg dexmedetomidine was infused over 10 min via radial artery 30 min before aortic clamping;CON group:0.9% normal saline was infused instead.Blood sample was taken from the radial artery immediately before induction of anesthesia(T0) and at 2,4,8,12 h after aortic unclamping(T1~T4) for determination of plasma concentration of cardiac troponin(cTnI),malondialdehyde(MDA),creatine kinase isoenzyme-MB(CK-MB) and superoxide dismutase(SOD).Hemodynamic data were recorded before induction of anesthesia(H1),after endotracheal intubation(H2),before and after study drug(or SP) loading dose(H3,H4),and at 0 min(H5),30 min(H6),1 h(H7),2 h(H8) after CPB.Hemodynamic data included heart rate(HR),mean arterial pressure(MAP).The duration of CPB,time of aortic clamping,extubation time,duration of stay in ICU and myocardial contractility score and volume of drainage at 12 h after the operation were recorded.The resto-ration of spontaneous heart beat and adverse cardiovascular events were observed.Results Compared to H0,MAP of H5,H6 in CON group were significantly lower (P<0.01),HR of H5,H6 in CON group were significantly higher(P<0.01);Compared to CON groups,MAP of H5,H6 in DEX group were significantly higher(P<0.01),HR of H5,H6 in DEX group were significantly lower(P<0.01);Compared to T0,the plasma cTnI and MDA concentration and CK-MB were significantly higher at T1~T4 in two groups while the plasma SOD was significantly lower(P<0.01).Compared to CON group,the plasma cTnI and MDA concentration and CK-MB were significantly higher while the plasma SOD was significantly lower(P<0.01).Exudation time and duration of stay in ICU were significantly shorter.The myocardial contractility score at 12 h after the operation and incidence of adverse cardiovascular events were significantly lower(P<0.05).Conclusion Dexmedetomidine preconditioning can ameliorate myocardial I/R injury in patients undergoing cardiac valve replacement under CPB,and the mechanism is related to inhibition of lipid perexidation.关键词
右美托咪定/心肺转流术/心肌再灌注损伤/预处理Key words
dexmedetomidine/cardiopulmonary bypass/myocardial reperfusion injury/pretconditioning分类
医药卫生引用本文复制引用
蒋玲玲,胡宪文,鲍丽君,张野..右美托咪定预处理对瓣膜置换术患者缺血后心肌的影响[J].安徽医科大学学报,2017,52(6):859-863,5.基金项目
国家自然科学基金青年基金项目(编号:81200089) （编号:81200089）
