【罂粟摘要】右美托咪定对胸腔镜手术中血流动力学和心肌保护的影响

右美托咪定对胸腔镜手术中血流动力学和心肌保护的影响

贵州医科大学麻醉与心脏电生理课题组

翻译：严旭

编辑：宋雨婷

审校：曹莹

背景

本研究旨在探讨右美托咪定在胸腔镜辅助手术（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。

方法

接受TATS的患者分为2组：右美托咪定组（在麻醉前以0.5ug/kg泵注>10分钟，在维持期以0.5ug/kg泵注）和对照组（在麻醉前泵注正常生理盐水>10分钟）。记录的每位患者的心率（术前、术中最大值和术中最小值）、收缩压和舒张压、术中血流动力学数据和术中服用的心血管药物。进行了酶联免疫吸附试验，以评估心肌肌钙蛋白I（cTnI）、肌酸激酶同酶、肌红蛋白和N-末端前B型利钠肽（NT-proBNP）的术后水平。

结果

两组在年龄、性别、身高、体重、美国麻醉师协会分类等级、切除模式、手术时间、射血分数、基础心率以及收缩压和舒张压方面无显著差异。在右美托咪定组中，患者术中最大心率和舒张压下降，术后住院时间更短。右美托咪定组的术后外周血液检查显示NT-proBNP水平较高，cTnI水平较低。

结论

术前给予右美托咪定有利于血流动力学稳定，在术中和术后保护心血管系统，并缩短术后住院时间。

原始文献来源：  

Hua Li , Ji Liu , Hong Shi ,Effect of Dexmedetomidine on Perioperative Hemodynamics and Myocardial Protection in Thoracoscopic-Assisted Thoracic Surgery [j]. Randomized Controlled TrialMed Sci Monit. 2021 Aug 3;27:e929949.

英文原文

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

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.

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