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右美托咪定对胸腔镜辅助下胸腔手术围手术期血液动力学及心肌保护的影响。

Effect of Dexmedetomidine on Perioperative Hemodynamics and Myocardial Protection in Thoracoscopic-Assisted Thoracic Surgery.

机构信息

Department of Anesthesiology, Shanghai Pulmonary Hospital, Shanghai, China (mainland).

出版信息

Med Sci Monit. 2021 Aug 3;27:e929949. doi: 10.12659/MSM.929949.

Abstract

BACKGROUND This study aimed to clarify the protective role of dexmedetomidine in thoracoscopic-assisted thoracic surgery (TATS), including control of the intraoperative heart rate, blood pressure, and myocardial injury markers. MATERIAL AND METHODS The patients who underwent TATS were divided into 2 equal groups: the dexmedetomidine group (dexmedetomidine pumped at 0.5 µg/kg for >10 min before the administration of anesthesia and at 0.5 µg/kg in the maintenance period) and the control group (pumped normal saline for >10 min before the administration of anesthesia). The data recorded for each patient were heart rate (preoperative, maximum intraoperative, and minimum intraoperative), systolic and diastolic blood pressure, intraoperative hemodynamic data, and intraoperative cardiovascular drugs administered. An enzyme-linked immunosorbent assay was performed to assess the postoperative levels of cardiac troponin I (cTnI), creatine kinase isoenzyme, myoglobin, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). RESULTS There were no significant differences in the age, sex, body height, body weight, American Society of Anesthesiologists classification grade, resection mode, operation time, ejection fraction, basal heart rate, and systolic and diastolic blood pressure of the 2 groups. In the dexmedetomidine group, the patients' maximum intraoperative heart rate and diastolic pressure decreased, and the postoperative hospital stay period was shorter. The postoperative peripheral blood test for the dexmedetomidine group showed higher NT-proBNP levels and lower cTnI levels. CONCLUSIONS Preoperative administration of dexmedetomidine can benefit hemodynamic stability, protect the cardiovascular system in the intraoperative and postoperative periods, and shorten postoperative hospitalization.

摘要

背景

本研究旨在阐明右美托咪定在胸腔镜辅助胸腔手术(TATS)中的保护作用,包括控制术中心率、血压和心肌损伤标志物。

材料和方法

接受 TATS 的患者分为两组:右美托咪定组(麻醉前 10 分钟以上泵注 0.5μg/kg 右美托咪定,维持期泵注 0.5μg/kg)和对照组(麻醉前 10 分钟以上泵注生理盐水)。记录每位患者的心率(术前、术中最大、术中最小)、收缩压和舒张压、术中血流动力学数据以及术中给予的心血管药物。采用酶联免疫吸附试验检测术后心肌肌钙蛋白 I(cTnI)、肌酸激酶同工酶、肌红蛋白和 N 端 pro-B 型利钠肽(NT-proBNP)水平。

结果

两组患者的年龄、性别、身高、体重、美国麻醉医师协会分级、切除方式、手术时间、射血分数、基础心率和收缩压无显著差异。右美托咪定组患者术中最大心率和舒张压降低,术后住院时间缩短。右美托咪定组术后外周血检查显示 NT-proBNP 水平升高,cTnI 水平降低。

结论

术前给予右美托咪定可改善血流动力学稳定性,保护围术期心血管系统,缩短术后住院时间。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be9e/8348991/001536652174/medscimonit-27-e929949-g001.jpg

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