摘要
目的探讨右美托咪定对胃肠道肿瘤患者腹腔热灌注化疗(IPHC)围术期的心肌保护作用。方法选择邯郸市中心医院2014年5月—2015年5月收治的行胃肠癌根治术的胃肠道肿瘤患者48例,均在胃肠癌根治术后行IPHC,采用随机数字表法分为高剂量右美托咪定组(D1组)、低剂量右美托咪定组(D2组)和对照组(C组),每组16例。麻醉诱导前,D1组和D2组患者分别静脉泵注右美托咪定1μg/kg负荷量,诱导后再分别匀速静脉泵注右美托咪定0.5μg·kg-1·h-1(D1组)和0.2μg·kg-1·h-1(D2组)至手术结束前30 min;C组采用同样方法静脉泵注等量0.9%氯化钠溶液。比较3组患者灌注前10 min(T1)、灌注开始后30 min(T2)、60 min(T3)及灌注结束后30min(T4)血流动力学指标〔包括心率(HR)、平均动脉压(MAP)及血氧饱和度(Sp O2)〕;比较3组患者T1、T2、T3、T4及术后24 h(T5)、72 h(T6)心肌酶学指标〔包括血清肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白I(c Tn I)水平〕。结果 3组患者T1时HR和MAP及T1、T2、T3、T4时Sp O2比较,差异均无统计学意义(P>0.05);T2、T3、T4时D1和D2组患者HR低于C组、D1组患者MAP低于C组,T3时D2组患者MAP低于C组(P<0.05)。T1、T3及T6时3组患者血清CK-MB水平比较,差异无统计学意义(P>0.05);T4、T5时D1组和D2组患者血清CK-MB水平低于C组,D1组患者血清CK-MB水平低于D2组(P<0.05)。T1、T3时3组患者血清c Tn I水平比较,差异无统计学意义(P>0.05);T4、T5、T6时D1组和D2组患者血清c Tn I水平低于C组,T4、T5时D1组患者血清c Tn I水平低于D2组(P<0.05)。结论右美托咪定对胃肠道肿瘤患者ICPH围术期心肌具有保护作用,且高剂量右美托咪定的心肌保护作用更强。
Objective To investigate the perioperative myocardial protective action of dexmedetomidine in gastrointestinal cancer patients treated by intraoperative peritoneal hyperthermic chemotherapy（IPHC）.Methods A total of 48 gastrointestinal cancer patients were selected in Handan Centeral Hospital from May 2014 to May 2015,all of them received gastrointestinal cancer radical operation and IPHC.According to random number table,all of the patients were divided into D1 group,D2 group and C group,each of 16 cases.Before anesthesia induction,patients of D1 group and D2 group received intravenous pumping of dexmedetomidine（1 μg / kg）; after anesthesia induction,patients of D1 group received uniform intravenous pumping of dexmedetomidine（0.5 μg · kg^-1· h^-1）,while patients of D2 group received uniform intravenous pumping of dexmedetomidine（0.2 μg · kg^-1·h^-1）.Patients of C group received same amount of intravenous pumping of0.9% sodium chloride injection.Hemodynamic index（including HR,MAP and Sp O2）before 10 minutes of IPHC,after 30 minutes and 60 minutes of IPHC,after 30 minutes of the end of IPHC was compared among the three groups,respectively;myocardial enzymological index（including serum levels of CK-MB and c Tn I）before 10 minutes of IPHC,after 30 minutes,24 hours and 60 minutes of IPHC,after 30 minutes,24 hours and 72 hours of the end of IPHC was compared among the three groups,respectively.Results No statistically significant differences of HR or MAP was found among the three groups before 10 minutes of IPHC,nor was Sp O2 among the three groups before 10 minutes of IPHC,after 30 minutes or 60 minutes of IPHC,or after 30 minutes of the end of IPHC（P〉0.05）; after 30 minutes,24 hours and 60 minutes of IPHC,after 30 minutes of the end of IPHC,HR of D1 group,D2 group was statistically significantly lower than that of C group,respectively,MAP of D1 groupwas statistically significantly lower than that of C,respectively（P〈0.05）; MAP of D2 group was statistically significantly lower
出处
《实用心脑肺血管病杂志》
2015年第10期75-78,共4页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
胃肠道肿瘤
腹腔热灌注化疗
右美托咪定
围手术期
心肌保护
Gastrointestinal neoplasms
Intraperitoneal perfusion chemotherapy
Dexmedetomidine
Perioperative period
Myocardial preservation
