右美托咪定对冠状动脉旁路移植术患者左室射血分数、血清肌钙蛋白、肿瘤坏死因子-α及白介素-10的影响

摘要

目的探讨右美托咪定对冠状动脉旁路移植术(coronary artery bypass grafting,CABG)患者左室射血分数(left ventricular ejection fraction,LVEF)、血清肌钙蛋白(cardiac troponin,cTn)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-a)及白介素(interleukin,IL)-10的影响.方法选取2013年11月至2017年1月菏泽市立医院收治的于体外循环下行CABG的80例患者为研究对象,采用随机数表法将其分为对照组、低剂量组、中剂量组、高剂量组,每组各20例.低剂量组、中剂量组、高剂量组患者分别于体外循环开始前静脉注射右美托咪定0.5、0.75、1.0μg/kg,对照组患者不进行任何处理.比较四组患者麻醉前、体外循环结束时、手术结束时、术后6小时及术后24小时的LVEF、cTnI、cTnT、TNF-α及IL-10水平.结果体外循环结束时、手术结束时、术后6小时、术后24小时,低剂量组、中剂量组、高剂量组患者LVEF均高于对照组(P<0.05),cTnI、cTnT、TNF-α、IL-10水平均显著低于对照组(P<0.05).术后6小时和术后24小时,低剂量组、中剂量组、高剂量组患者血清TNF-α、IL-10水平均显著低于手术结束时(P<0.05).结论静脉注射0.5~1.0μg/kg右美托咪定,对体外循环下行CABG患者的缺血再灌注损伤心肌具有一定的保护作用,其保护机制可能与提高LVEF,降低血清cTnI、cTnT、TNF-α及IL-10水平有关.%Objective To investigate the effect of Dexmedetomidine on left ventricular ejection fraction (LVEF), tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10) and serum troponin (cTn) in patients underwent coronary artery bypass grafting (CABG). Method 80 patients underwent CABG were selected from November 2013 to January 2017 in Heze Municiple Hospital as research objects, they were randomly divided into control group, low-dose group (injected 0.5μg/kg Dexmedetomidine before extracorporeal circulation), medium-dose group (injected 0.75μg/kg Dexmedetomidine before extracorporeal circulation) and high-dose group (injected 1.0μg/kg Dexmedetomidine before extracorporeal circulation), patients in control group received no treatment. Before anesthesia, at the end of extracorporeal circulation, at the end of operation, 6 hours after operation and 24 hours after operation, LVEF, cTnI, cTnT, TNF-α and IL-10 levels were detected and compared. Result At the end of extracorporeal circulation, at the end of operation, 6 hours after operation and 24 hours after operation, LVEF of low-dose group, medium-dose group and high-dose group were higher than those of control group (P<0.05). The levels of cTnI, cTnT, TNF-α and IL-10 were lower than those of control group (P<0.05). 6 hours after operation and 24 hours after operation, levels of TNF-α and IL-10 of low-dose group, medium-dose group and high-dose group were lower than those at the end of operation (P<0.05). Conclusion For patients underwent CABG, intravenous inject 0.5~1.0μg/kg Dexmedetomidine has a protective effect on myocardial with is chemical reperfusion injury, the mechanism of the protection may be related to the decrease of levels of serum cTnI, cTnT, TNF-α and IL-10 and improve the patients with LVEF.