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| 右美托咪定对二尖瓣置换术患者左右心室收缩和舒张功能的影响 |
| Effects of dexmedetomidine on systolic and diastolic function of the left and right ventricles in patients undergoing mitral valve replacement |
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| DOI：10.12089/jca.2020.09.003 |
| 中文关键词: 右美托咪定 心室功能，左 心室功能，右 心脏瓣膜假体植入 超声心动图描记术 |
| 英文关键词: Dexmedetomidine Ventricular function, left Ventricular function, right Heart valve prosthesis implantation Transesophageal echocardiography |
| 基金项目: |
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| 中文摘要: |
目的 观察右美托咪定对心肺转流（CPB）下行二尖瓣置换术患者左右心室收缩和舒张功能的影响。
方法 择期CPB下行二尖瓣置换术患者32例，男9例，女23例，年龄42～70岁，BMI 18~28 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法分为两组:右美托咪定组（D组）和对照组（C组）。两组术中麻醉维持均采用静脉复合麻醉，D组于切皮后经微量注射泵静脉注射右美托咪定负荷剂量1 μg/kg，10 min内注射完后以0.5 μg·kg-1·h-1维持给药至术毕，C组静脉注射等量生理盐水。于麻醉诱导后（T0）、CPB停机后30 min(T1)、60 min(T2)记录HR、MAP、CVP、心脏指数（CI）、左心室射血分数(LVEF)等血流动力学指标，并于同时点记录二尖瓣瓣环等容收缩期峰值速度（Sm1）、射血期峰值速度（Sm2）、二尖瓣舒张早期血流峰值速度与二尖瓣瓣环舒张早期峰值速度的比值（E/Ea-MV）、三尖瓣瓣环等容收缩期峰值速度（St1）、射血期峰值速度（St2）、三尖瓣舒张早期峰值速度与三尖瓣瓣环舒张早期血流峰值速度的比值（E/Ea-TV）。
结果 与T0时比较，T1—T2时两组HR明显增快（P<0.05），MAP明显降低（P<0.05），CVP、CI明显升高（P<0.05）。T0—T2时两组HR、MAP、CVP、CI、LVEF差异均无统计学意义。T0—T2时两组Sm1、Sm2、E/Ea-MV组内组间差异均无统计学意义。与T0时比较，T1—T2时C组E/Ea-TV明显升高，T2时D组E/Ea-TV明显升高（P<0.05）。T0—T2时两组St1、St2、E/Ea-TV差异无统计学意义。
结论 右美托咪定并不能改善左右心室舒张功能受损的程度，亦未增加心肌受损程度。 |
| 英文摘要: |
Objective To evaluate effects of dexmedetomidine on systolic and diastolic function of the left and right ventricles in patients undergoing mitral valve replacement (MVR) under cardiopulmonary bypass (CPB).
Methods Thirty-two patients, 9 males and 23 females, aged 42-70 years, BMI 18-28 kg/m2, ASA physical status Ⅱ or Ⅲ, undergoing MVR under CPB were randomized into dexmedetomidine group (group D) and control group (group C). Total intravenous anesthesia was used in both groups. In group D, 1 μg/kg bolus dose of dexmedetomidine was administered within 10 min after surgical incision, followed by a 0.5 μg·kg-1·h-1 intravenous injection until the end of operation, while the same amount of normal saline was used instead of dexmedetomidine in group C. HR, MAP, CVP, cardiac index (CI), left ventricular ejection fraction (LVEF), left ventricle myocardial mechanics parameters such as Sm1, Sm2, E-MV, Ea-MV, and right ventricle myocardial mechanics parameters like St1, St2, E-TV, Ea-TV were recorded after anesthesia induction (T0), at 30 min after CPB (T1), and 60 min after CPB(T2).
Results Compared with T0, HR, CVP and CI significantly increased at T1 - T2 in both groups (P < 0.05), while MAP significantly decreased (P < 0.05). While comparison of HR, MAP, CVP, CI, and LVEF had no significance between the two groups. Sm1, Sm2, E/Ea-MV, St1, St2 and E/Ea-TV in group D compared with these in group C showed no statistical differences. Compared with T0, E/Ea-TV significantly increased at T1 - T2 in group C and at T2 in group D (P<0.05).
Conclusion Dexmedetomidine couldnt improve the impaired diastolic function of left and right ventricle. It didn’t increase the degree of myocardial injury. |
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