右美托咪定对经皮左心耳封堵术患者心肌保护效应-浙江医学杂志社.docVIP

右美托咪定在经皮左心耳封堵术中的应用( 郑君刚 王伟飞 曹刚 钱幸尔 陈勇杰 王冠军 郁一波 卢子会 黄长顺 宁波市第一医院麻醉科 浙江宁波 315010 摘要 目的 拟评价右美托咪定在经皮左心耳封堵术中的应用价值。方法 选取非瓣膜性房颤卒中风险评分（CHA2DS2-VAS评分）≥2分拟行经皮左心耳封堵术的房颤患者80例，ASA分级Ⅱ或Ⅲ级，NYHA分级Ⅱ或Ⅲ级，随机数字表法分成2组：对照组(C组)和右美托咪定组(D组)，每组40例。D组全身麻醉诱导插管前10 min静脉泵注右美托咪定负荷剂量0.5~1 μg/kg，随后以0.4 μg/（kg·h）C组则给予等容量生理盐水对照，两组术中维持BIS值40～60cTnI)的浓度。入室后（T0）、气管插管即刻(T1)、经食道超声探头（TEE）置入即刻(T2)、封堵器放置即刻(T3)及拔除气管导管即刻(T4)记录收缩压（SP）、舒张压（DP）、平均动脉压（MAP）及心率（HR），同时记录术中封堵器一次性释放到位率、心血管不良反应的发生率情况、总手术时间及住院时间。结果 与C组比较，D组术后6小时、48小时血清cTnI的浓度明显降低(P0.05)，D组患者围术期血流动力学指标更平稳，术中封堵器一次性释放到位率明显高于C组(P0.05)，心血管不良反应的发生率更低(P0.05)，两组患者总手术时间及住院时间没有明显差异。结论 右美托咪定的应用对经皮左心耳封堵术患者心肌损伤起到一定的保护作用，更有利于维持患者血流动力学的平稳，减少术中心血管不良反应的发生率，便于术者介入手术操作。 关键词：右美托咪定；经皮左心耳封堵；房颤；心肌 Effects of dexmedetomidine in percutaneous left atrial appendage closure ZHENG Jungang, WANG Weifei, CAO Gang，QIAN Xinger, CHEN Yongjie，, YU Yibo，LU Zihui，HUANG Changshun．Department of Anesthesiology，First Hospital of Ningbo，Ningbo 315010，China． Corresponding author：HUANG Changshun，Department of Anesthesiology，First Hospital of Ningbo，Ningbo 315010，China．Email：nbhcs1967@163.com 0bjective To evaluate the effect of dexmedetomidine in patients with percutaneous left atrial appendage closure．Eighty ASA II or Ⅲ, NYHA II or Ⅲ patients with non-valvular atrial fibrillation，CHADS2-VAS score≥2，undergoing ercutaneous left atrial appendage closure，were randomized into 2 groups(n=0 each) using a random number table：control group(group C)and dexmedetomidine group(group D)．Dexmedetomidine 0. μg/kg was infused intravenously over 10 min prior to induction of anesthesia in group D while the group C was given saline．BIS was maintained at 40~60 during operation. Before administration and at 6 h、48 h after surgery，the levels of cTnI were measured and compared in the two group. After admission to operating room(T0，baseline)，immediately after intubation (T1)，immediately after TEE probe implantation (T2)，immediately after closure device release(T3)，mmediately after ?extubation (T4)，SP，DP，MAP and HR were reco