右美托咪定联合缺血预处理对心脏疾病患者非心脏手术心肌和肾损伤的保护作用

目的探讨右美托咪定联合缺血预处理对心脏疾病患者非心脏手术心肌和肾损伤的保护作用。方法选取2017年5月至2019年1月在我院拟行手术治疗的86例伴有心脏疾病的患者,采用随机数表法分为观察组(43例)及对照组(43例),所有患者均使用静吸复合全麻,观察组采用右美托咪定联合缺血预处理,对照组使用生理盐水。比较两组术中不良心血管事件的发生率,围手术期肌钙蛋白(cTnI)和肌酐(CR)水平,术后心肾不良反应发生率。结果两组术中低血压、高血压、心动过缓的发生率比较差异无统计学意义(P>0.05),观察组心动过速(2.33%vs.18.60%,χ^2=6.08,P=0.02)及心肌缺血(11.63%vs.53.49%,χ^2=17.16,P<0.01)的发生率低于对照组。入室时两组cTnI及Cr水平比较差异无统计学意义(P>0.05),术后两组cTnI及Cr水平均较入室时显著提高(P<0.05);观察组在术后1 h、8 h、24 h的cTnI水平显著低于对照组(P<0.05或P<0.01),在术后8 h、24 h的Cr水平低于对照组(P<0.01)。观察组术后急性肾损伤(AKI)(20.93%vs.44.19%)及室性心律失常(39.53%vs.83.72%)的发生率显著低于对照组,差异有统计学意义(P<0.05)。结论右美托咪定联合缺血预处理可有效保护心脏患者非心脏手术中的心肾功能。

Protective effects of dexmedetomidine combined with ischemic preconditioning on myocardial and renal injury during non-cardiac surgery in patients with heart disease

Objective To explore the protective effects of dexmedetomidine combined with ischemic preconditioning on myocardial and renal injury during non-cardiac surgery in patients with heart disease.Methods Totally 86 patients with heart disease undergoing non-cardiac surgery in our hospital from May 2017 to January 2019 were selected,and they were divided into observation group(n=43)and control group(n=43)by random number table method.All patients were given inhalation anesthesia,and patients in observation group were given dexmedetomidine combined with ischemic preconditioning,while patients in control group were given normal saline.The incidence of adverse cardiovascular events during operation,perioperative troponin(cTnI)and creatinine(CR)levels,and the incidence of postoperative cardiac and renal adverse reactions were compared between the two groups.Results There was no significant difference in the incidence of hypotension,hypertension or bradycardia during operation between the two groups(P>0.05);the incidence of tachycardia(2.33%vs.18.60%,χ^2=6.08,P=0.02)and myocardial ischemia(11.63%vs.53.49%,χ^2=17.16,P<0.01)in observation group were lower than those in control group.There was no significant difference in the levels of cTnI or CR between the two groups when entering the operating room(P>0.05),and those levels in both groups were increased after operation.The levels of cTnI in observation group at 1 h,8 h and 24 h after operation and the levels of CR at 8 h and 24 h after operation were lower than those in control group(P<0.05 or P<0.01).The incidence rates of acute kidney injury(AKI)(20.93%vs.44.19%)and ventricular arrhythmia(39.53%vs.83.72%)in observation group were lower than those in control group after treatment(P<0.05).Conclusion Dexmedetomidine combined with ischemic preconditioning can effectively protect the heart and renal function during non-cardiac surgery in patients with heart disease.