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右美托咪定对老年冠心病患者围手术期心脏不良事件的影响

[Effects of dexmedetomidine on perioperative cardiac adverse events in elderly patients with 
coronary heart disease].

作者信息

Shen Junmei, Sun Yanjiang, Han Ding, Zhu Kangsheng, Zhao Wei

机构信息

Department of Anesthesiology, Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China

Department of Anesthesiology, Jimo People's Hospital, Jimo Shandong 266200, China.

出版信息

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2017 May 28;42(5):553-557. doi: 10.11817/j.issn.1672-7347.2017.05.012.

Abstract

To investigate the effects of dexmedetomidine on perioperative cardiac adverse events in elderly patients with coronary heart disease.
 Methods: Sixty elderly patients, who were diagnosed as coronary heart disease and underwent gastric cancer operation, were randomly divided into 2 groups (n=30): the dexmedetomidine group (Dex group) and the control group. In the Dex group, dexmedetomidine was administered intravenously at 0.5 μg/(kg·h) after a bolus infusion at 0.5 μg/kg for 10 min before anesthesia induction. In the control group, equal volume of normal saline was infused instead of dexmedetomidine. The 2 groups received the same anesthesia treatment. The venous bloods were collected at the preoperative 0 h and postoperative 24 h. The concentrations of cardiac troponin (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP) and hypersensitive C-reactive protein (hs-CRP) were determined. The ECG was monitored at the above time and the postoperative incidence of cardiac adverse events was recorded.
 Results: The levels of cTnI, NT-proBNP and hs-CRP in serum were elevated in the 2 groups after the operation. Compared with the control group, the levels of cTnI, NT-proBNP and hs-CRP were significantly decreased in the Dex group (P<0.05). Compared with the control group, the incidence of bradycardia were significantly increased, while the myocardial ischemia and tachycardia were significantly decreased in the Dex group during the operation (P<0.05); the incidence of silent myocardial ischemia and arrhythmia was significantly reduced at 3 days after operation in the Dex group (P<0.05).
 Conclusion: Dexmedetomidine could decrease the incidence of cardiac adverse events in elderly patients with coronary heart disease.

摘要

探讨右美托咪定对老年冠心病患者围手术期心脏不良事件的影响。方法:选取60例诊断为冠心病并接受胃癌手术的老年患者,随机分为2组(n = 30):右美托咪定组(Dex组)和对照组。Dex组在麻醉诱导前10分钟静脉推注0.5μg/kg右美托咪定,随后以0.5μg/(kg·h)持续静脉输注。对照组输注等量生理盐水替代右美托咪定。两组接受相同的麻醉处理。于术前0小时和术后24小时采集静脉血,测定心肌肌钙蛋白(cTnI)、N末端脑钠肽前体(NT-proBNP)和超敏C反应蛋白(hs-CRP)的浓度。在上述时间点监测心电图,并记录术后心脏不良事件的发生率。结果:两组患者术后血清cTnI、NT-proBNP和hs-CRP水平均升高。与对照组相比,Dex组cTnI、NT-proBNP和hs-CRP水平显著降低(P < 0.05)。与对照组相比,Dex组术中心动过缓发生率显著增加,而心肌缺血和心动过速发生率显著降低(P < 0.05);Dex组术后3天无症状性心肌缺血和心律失常发生率显著降低(P < 0.05)。结论:右美托咪定可降低老年冠心病患者心脏不良事件的发生率。

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