右美托咪定对高脂血症冠心病患者腹腔镜手术围术期血小板活化的影响

中国临床药理学与治疗学 ›› 2017, Vol. 22 ›› Issue (11): 1269-1273.

右美托咪定对高脂血症冠心病患者腹腔镜手术围术期血小板活化的影响

徐巧敏¹，吴玮凌²，章玲宾¹，樊理华¹，游敏吉¹，李坤旺¹

¹浙江省丽水市人民医院麻醉科，丽水 323000，浙江；² 浙江省丽水市莲都区人民医院妇产科，丽水 323000，浙江

收稿日期:2017-03-27 修回日期:2017-04-24 出版日期:2017-11-26 发布日期:2017-12-11
通讯作者: 章玲宾，男，本科，副主任医师，研究方向：麻醉药物治疗学。 Tel:18957090895 E-mail:13372380895@126.com

Effects of dexmedetomidine on platelet activation during perioperative period in patients with coronary heart disease underwent laparoscopic surgery

XU Qiaomin ¹, WU Weiling², ZHANG Linbin ¹, FAN Lihua¹, YOU Minji¹, LI Kunwang¹

¹ Department of Anesthesiology, Lishui People's Hospital of Zhejiang (the Sixth Affiliated Hospital of Wenzhou Medical University); ²Department of Obstetrics and Gynecology, Liandu People's Hospital of Lishui, Lishui 323000, Zhejiang, China

Received:2017-03-27 Revised:2017-04-24 Online:2017-11-26 Published:2017-12-11

摘要/Abstract

摘要：

目的: 观察右美托咪定对高脂血症冠心病患者腹腔镜手术围术期血小板活化反应的影响。方法:选取60例行腹腔镜胆囊切除的高脂血症冠心病患者，美国麻醉师协会(ASA) 分级Ⅱ～Ⅲ 级，心功能Ⅰ～Ⅱ级，且所有患者无严重心律失常。按就诊顺序随机分为4 组：右美托咪定0.4 μg/kg（D1组）、0.6 μg/kg（D2组）、0.8 μg/kg（D3组）和生理盐水（C组），每组15例。麻醉诱导前静脉输注右美托咪定0.4 μg/kg（D1组）、0.6 μg/kg（D2组）、0.8 μg/kg（D3组）或生理盐水（C组），容量均为10 mL，输注时间10 min，4组患者麻醉方法相同。予给药前、给药后1 h、给药后2 h抽取肘静脉血测定血小板活化标志物：CD62P、GPⅡb/Ⅲa复合物，并记录失血量，术后8 h内采用视觉模拟法(VAS)评分评价疼痛程度及Ramsay评分评价镇静程度。结果:各组CD62P和GPⅡb/Ⅲa复合物表达均上调；与C组比较，D1、D2组和D3组T2及T3时点CD62P和GPⅡb/Ⅲa复合物表达下调（P<0.05），组间比较，D3组上调小于D1、D2组，且D2组上调小于D1组；与C组比较，D1、D2组和D3组术后VAS评分下降（P<0.05）；与C组比较，术毕及术后2 h，D1、D2组和D3组术后Ramsay评分上调（P<0.05），但术后4 h及术后8 h各组Ramsay评分比较无统计学意义（P>0.05）。结论:右美托咪定能在一定程度上降低高脂血症冠心病患者腹腔镜手术围术期血小板活化标志物的表达，降低术后疼痛评分且过度镇静状态出现，安全有效。

关键词: 右美托咪定, 冠心病, 血小板活化, 镇痛镇静评分

Abstract:

AIM: To observe the effects of dexmedetomidine on platelet activation during perioperative period in patients with coronary heart disease underwent laparoscopic surgery. METHODS: Sixty patients of coronary heart disease who underwent laparoscopic surgery and were assessed as grade Ⅱ-Ⅲ according to American Society of Anesthesiologists (ASA) standard and gradeⅠ-Ⅱ according to cardiac function. All patients were observed without severe arrhythmia and were randomly divided into four groups according to the order of treatment: dexmedetomidine 0.4 μg/kg (group D1), 0.6 μg/kg (group D2), 0.8 μg/kg (group D3) and normal saline (group C) (n=15). Before induction of anesthesia,10 Ml dexmedetomidine infusion of 0.4 μg/kg (group D1), 0.6 μg/kg (group D2), 0.8 μg/kg (group D3) or normal saline (group C) for 10 min; four groups of patients received same anesthesia. The platelet activation markers CD62P and GPⅡb/Ⅲa were measured before, 1 h and at 2 h after administration. The blood loss was recorded and the pain severity was evaluated by VAS within 8 h after operation. Ramsay score was used to assess the degree of sedation.RESULTS:The expression of CD62P and GPⅡb/Ⅲa complexes in each group was up-regulated. Compared with group C, the expressions of CD62P and GPⅡb/Ⅲa complexes in group D1, D2 and D3 were down-regulated at T2 and T3 time points (P<0.05); D3 group was less than D1 and D2 group, and D2 group was less than D1 group. Compared with group C, the VAS scores in group D1, group D2 and group D3 were significantly lower than those in group C after the operation (P<0.05). Compared with group C, the postoperative Ramsay score was up-regulated in the D1, D2 and D3 groups (P<0.05), but there was no significant difference in the Ramsay scores between the 4th and 8th hour after operation (P>0.05).CONCLUSION:Dexmedetomidine can reduce the expression of platelet activation markers in patients with coronary heart disease during perioperative period of laparoscopic surgery. The postoperative pain score is decreased and no excessive sedation is observed.

中图分类号:

R614

徐巧敏，吴玮凌，章玲宾，樊理华，游敏吉，李坤旺. 右美托咪定对高脂血症冠心病患者腹腔镜手术围术期血小板活化的影响[J]. 中国临床药理学与治疗学, 2017, 22(11): 1269-1273.

XU Qiaomin, WU Weiling, ZHANG Linbin, FAN Lihua, YOU Minji, LI Kunwang. Effects of dexmedetomidine on platelet activation during perioperative period in patients with coronary heart disease underwent laparoscopic surgery[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2017, 22(11): 1269-1273.

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