【摘要】：目的 觀察鹽酸右美托咪定(Dex)對AMI患者PCI術(shù)中的鎮(zhèn)靜、鎮(zhèn)痛、抗焦慮、減輕應(yīng)激反應(yīng)、減輕炎癥反應(yīng)的作用，評價(jià)Dex對心肌細(xì)胞的保護(hù)作用及其對預(yù)后的影響；觀察Dex對肝腎功能的影響，評價(jià)應(yīng)用Dex的安全性及有效性，為臨床挽救更多心肌提供一種安全、有效的方法。 方法 收集2012年08月至2013年03月就診于我院心血管內(nèi)科初發(fā)AMI發(fā)病12h內(nèi)入院的患者60例，將符合入選標(biāo)準(zhǔn)的患者隨機(jī)分為2組：對照組(C組)30例接受常規(guī)PCI治療，鹽酸右美托咪定組(D組)30例在常規(guī)PCI治療過程中給予靜脈微泵注射Dex，術(shù)中根據(jù)鎮(zhèn)靜評分(RASS評分)和疼痛評分(VAS評分)增加或減少藥物劑量，術(shù)后停止注射。記錄所有患者在給藥前(T0)及給藥后10min(T1)、30min(T2)、1h(T3)、2h(T4)、4h(T5)、12h(T6)的收縮壓(SBP)、舒張壓(DBP)和心率(HR)變化。分別于術(shù)前及術(shù)后8h、16h、24h、48h、72h測定血清心肌肌鈣蛋白(IcTnI)和血清肌酸激酶同工酶(CK-MB)濃度。分別于術(shù)前和術(shù)后24h測定超敏C反應(yīng)蛋白(hsCRP)濃度和中性粒細(xì)胞計(jì)數(shù)(ANC)。所有患者術(shù)前和術(shù)后1月分別行心臟超聲檢查，測定左心室射血分?jǐn)?shù)(LVEF)及室壁運(yùn)動(dòng)記分指數(shù)(WMSI)的變化。于術(shù)前和術(shù)后24h測定血清肌酐(Scr)、血尿素氮(BUN)、胱抑素C(CysC)、谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)濃度，并記錄兩組患者術(shù)后24h內(nèi)總尿量。 結(jié)果 1兩組患者的性別、年齡、危險(xiǎn)因素、術(shù)前時(shí)間、冠脈病變程度、支架植入情況和術(shù)后用藥情況等無統(tǒng)計(jì)學(xué)差異(P0.05)。 2兩組患者在T0時(shí)點(diǎn)SBP、DBP和HR相比無顯著性差異(P0.05)。與T0相比，D組在T1、T2、T3、T4、T5、T6時(shí)點(diǎn)SBP、DBP、HR顯著降低(P0.05)；C組T1、T2、T3、T4、T5、T6時(shí)點(diǎn)SBP、DBP、HR與T0比較顯著升高(P0.05)。在T1、T2、T3、T4、T5、T6各時(shí)點(diǎn)D組的SBP、DBP、HR顯著低于C組(P0.05)。 3C組和D組PCI術(shù)前cTnI、CK-MB比較，差異無統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后D組患者cTnI、CK-MB峰濃度明顯低于C組，差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 4術(shù)前hsCRP濃度、ANC兩組比較均無明顯統(tǒng)計(jì)學(xué)差異(P0.05)；但術(shù)后24h，D組的hsCRP濃度、ANC明顯低于C組，差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 5術(shù)前兩組患者LVEF值和WMSI值比較無明顯統(tǒng)計(jì)學(xué)差異(P0.05)；但術(shù)后1月，D組的LVEF值明顯高于C組(P0.05)，，WMSI值明顯低于C組，差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 6C組患者術(shù)前和術(shù)后24hScr、BUN、CysC比較，差異無統(tǒng)計(jì)學(xué)意義(P0.05)；D組患者術(shù)后24hScr、BUN、CysC較術(shù)前明顯降低，差異有統(tǒng)計(jì)學(xué)意義(P0.05)。C組和D組患者術(shù)前Scr、BUN、CysC、ALT、AST比較，差異無統(tǒng)計(jì)學(xué)意義(P0.05)；術(shù)后24hD組患者Scr、BUN、CysC較C組明顯降低，差異有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后24h兩組間ALT、AST比較，未見明顯差異(P0.05)。D組患者術(shù)后24h內(nèi)總尿量較C組明顯增多，差異有統(tǒng)計(jì)學(xué)意義(P0.05)。 結(jié)論 1PCI術(shù)中靜脈應(yīng)用Dex，對AMI患者產(chǎn)生鎮(zhèn)靜、鎮(zhèn)痛、抗焦慮作用，減輕應(yīng)激反應(yīng)。 2PCI術(shù)中對AMI患者靜脈應(yīng)用Dex，可減輕患者的炎癥反應(yīng)。 3PCI術(shù)中對AMI患者靜注Dex，可減輕心肌的進(jìn)一步損傷，產(chǎn)生心肌保護(hù)作用，且改善預(yù)后。 4Dex具有腎臟保護(hù)作用，且對肝功能無損害，應(yīng)用安全有效。
[Abstract]:objective
To observe the effects of dexmedetomidine hydrochloride (Dex) on sedation, analgesia, anti-anxiety, stress relief and inflammatory reaction in patients with AMI undergoing PCI, to evaluate the protective effect of Dex on myocardial cells and its prognosis, to observe the effect of Dex on liver and kidney function, to evaluate the safety and effectiveness of Dex in order to save more myocardium for clinical use. For a safe and effective way.
Method
Sixty patients hospitalized within 12 hours of the onset of AMI in our hospital from August 2012 to March 2013 were randomly divided into two groups: 30 patients in control group (group C) received conventional PCI treatment, 30 patients in dexmedetomidine hydrochloride group (group D) received intravenous micropump Dex during conventional PCI treatment. Sedation score (RASS score) and pain score (VAS score) increased or decreased the dosage of the drug and stopped the injection after the operation. Serum SBP, DBP and HR were measured at 8, 16, 24, 48 and 72 hours before and after the administration (T0) and 10 minutes (T1), 30 minutes (T2), 1 hour (T3), 2 hours (T4), 4 hours (T5), 12 hours (T6). The levels of cardiac troponin (IcTnI) and serum creatine kinase isoenzyme (CK-MB) were measured before operation and 24 hours after operation respectively. The levels of hypersensitive C-reactive protein (hsCRP) and neutrophil count (ANC) were measured before and 1 month after operation. Serum creatinine (Scr), blood urea nitrogen (BUN), cystatin C (CysC), alanine aminotransferase (ALT) and glutamic oxaloacetic transaminase (AST) were measured before and 24 hours after operation. The total urine volume of the two groups was recorded within 24 hours after operation.
Result
There were no significant differences in gender, age, risk factors, preoperative time, degree of coronary artery lesion, stent implantation and postoperative medication between the two groups (P 0.05).
Compared with T0, SBP, DBP and HR in group D at T1, T2, T3, T4, T5, T6 decreased significantly (P 0.05); SBP, DBP, HR in group C at T1, T2, T3, T4, T5, T6 increased significantly (P 0.05). SBP, DBP, HR in group D at T1, T2, T4, T5, T6 were significantly lower than those in group C (P 0.05).
There was no significant difference in cTnI and CK-MB between group 3C and group D before PCI (P 0.05); the peak concentrations of cTnI and CK-MB in group D after PCI were significantly lower than those in group C (P 0.05).
There was no significant difference in the concentration of hsCRP between ANC group and preoperative group (P 0.05), but the concentration of hsCRP in group D was significantly lower than that in group C 24 hours after operation (P 0.05).
There was no significant difference in LVEF and WMSI between the two groups before operation (P 0.05), but the LVEF in group D was significantly higher than that in group C (P 0.05) and the WMSI was significantly lower than that in group C (P 0.05).
Scr, BUN, CysC were significantly lower in group D than in group C (P 0.05). Scr, BUN, CysC were significantly lower in group C and group D (P 0.05). Scr, BUN, CysC, ALT and AST were significantly lower in group D than in group C (P 0.05). Scr, BUN, CysC were significantly lower in group D than in group C at 24 hours after operation (P 0.05). There was no significant difference in ALT and AST between the two groups 24 hours after operation (P 0.05). The total urine volume in group D was significantly higher than that in group C within 24 hours after operation (P 0.05).
conclusion
Intravenous Dex during PCI can produce sedation, analgesia, anti-anxiety and alleviate stress reaction in patients with AMI.
2PCI in patients with AMI Dex intravenous application, can reduce the inflammatory response of patients.
Intravenous injection of Dex in patients with AMI during 3PCI can alleviate further myocardial injury, produce myocardial protection and improve prognosis.
4Dex has a protective effect on the kidney, and has no damage to liver function, and is safe and effective.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R542.22

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