术中持续泵注艾司洛尔对椎体结核病灶清除术患者心肌的保护作用

摘要

目的:探讨术中持续泵注艾司洛尔对椎体结核病灶清除术患者心肌的保护作用.方法:行椎体结核病灶清除术患者78例,均分为对照组和观察组,对照组插管前3 min及手术过程中静脉持续泵注生理盐水;观察组持续泵注艾司洛尔(0.3 mg/kg);比较两组麻醉前(T0)、气管插管后即刻(T1)、麻醉后10 min(T2)、手术结束时(T3)、拔管即刻(T4)和拔管后30 min(T5)的平均动脉血压(MAP)、心率(HR)、及HR与收缩压(SBP)的乘积(RPP);于麻醉前、术后6及30 h时采集两组患者清晨空腹静脉血,采用酶联免疫吸附剂测定法血清肌钙蛋白Ⅰ(eTnⅠ)水平,免疫化学发光法检测血清乳酸脱氢酶(LDH)、肌酸激酶(CK)及肌酸激酶同工酶(CK-MB)水平.结果:观察组患者T1、T2及T4时点的HR、RPP及MAP均低于对照组(P＜0.05),T0、T3及T5时点的HR、RPP及MAP与对照组相比差异无统计学意义(P＞0.05);与对照组比较,观察组患者麻醉诱导前、术后6及30 h时的血清cTnⅠ、LDH、CK和CK-MB水平比较,差异均无统计学意义(P＞0.05).结论:术中持续泵注艾司洛尔可改善患者血流动力学,对心肌有保护作用.%Objective:To investigate the effect of intraoperative continuous aspiration of esmolol on myocardial protection in patients accepting vertebral tuberculosis focus clearance.Methods:78 patients accepting vertebral tuberculosis focus clearance from May 2015 to October 2016 were divided into two groups according to the number random table,39 cases in each group.In the control group,intravenous injection of saline was performed 3 min before intubation,and intraoperative continuous injection was performed.In the observation group,esmolol (0.3 mg/kg) was injected intravenously 3 min before intubation.The changes of HR,RPP,MAP indexes and the changes of serum cTnⅠ,LDH,CK and CK-MB levels of two groups before and after anesthesia induction were observed and recorded,and the results were compared and analyzed.Results:HR,RPP and MAP levels were significantly lower in the observation group T1,T2 and T4 than those in the control group (P ＜ 0.05).Conclusion:Intraoperative continuous infusion of esmolol can promote hemodynamic stability of patients with resected tuberculosis focus and has significant effect on myocardial protection,worthy of clinical promotion.