心肌声学造影监测盐酸右美托咪定影响冠状动脉供血 的临床研究

Effect of dexmedetomidine hydrochloride on coronary blood supply： A clinical study by myocardial contrast echocardiography

摘要:

目的：定量分析持续滴注盐酸右美托咪定患者不同用药时间的左室心肌声学造影结果，以评估盐酸右美托咪定对患者冠状动脉供血的影响。方法：52例手术中随机分为实验组与对照组，每组26例。实验组单纯应用盐酸右美托咪定麻醉的患者，于给药前、给药后10 min、给药后30 min、给药后1 h、停药时及停药2 h采集患者左室心肌声学造影图像，进入工作站定量分析不同时间心肌内造影剂声强度；对照组单纯应用丙泊酚，于相同时间点采集心肌造影数据。心肌声强度反映心肌内血流灌注情况，声强度差值增大，冠脉血流灌注减少，声强度差值减少，冠脉血流灌注增加。结果：各时间点差异有统计学意义（P<0.05），时间和分组的交互作用具有统计学意义（P<0.05），说明声强度差随时间的变化趋势在实验组和对照组不同。分组间差异无统计意义（P=0.268），说明分组因素不起作用，实验组和对照组声强度差总体而言没有统计学差异。实验组给药后10 min心肌声强度差值开始从4.82迅速减小到2.95，30 min后减小趋势降低，术后2 h声强度差值恢复至给药前状态。对照组心肌声强度变化不明显。结论：盐酸右美托咪定能扩张冠状动脉，达到增加术中患者心肌血供的目的。

Abstract:

Objective：To evaluate the effect of dexmedetomidine hydrochloride on the coronary blood supply of patients through quan－titative analysis of the left ventricular myocardial contrast echocardiography（MCE） results at different time points of continuous instil－lation of dexmedetomidine hydrochloride. Methods：A total of 52 intraoperative patients were randomly divided into experimental group（n=26） and control group（n=26）. The patients in the experimental group received general anesthesia with dexmedetomidine hydrochloride；the MCE images were collected at five different time points：before administration，at 10 min，30 min，and 1 h of administration，at the time of withdrawal，and at 2 h after withdrawal，and then a quantitative analysis was performed on the myocardial acoustic intensity of contrast agent at different time points in a workstation. The control group was given propofol，and the MCE data were collected at the same time points as the experimental group. The myocardial acoustic intensity reflected the blood perfusion in the myocardium；an increase in acoustic intensity difference indicated a reduction in coronary blood perfusion，while a reduction in acoustic intensity difference indicated an increase in coronary blood perfusion. Results：The acoustic intensity difference varied significantly at different time points（P<0.05）. There was a significant interaction between time and group（P<0.05），suggesting the changing trend in acoustic intensity difference over time was different between the experimental group and the control group. The acoustic intensity difference showed no significant difference between the two groups（P=0.268），indicating that the grouping factor had no influence. In the experimental group，the myocardial acoustic intensity difference decreased rapidly from 4.82 to 2.95 at 10 min of administration，and the decrease became slower at 30 min；the acoustic intensity difference returned to the value before administration at 2 h after operation. In the control group，there was no significant change in myocardial acoustic intensity. Conclusion：Dexmedeto－midine hydrochloride can dilate the coronary artery and thus increase the myocardial blood supply during operation.