目的 研究右美托咪定复合瑞芬太尼对心内直视手术心肌缺血再灌注后血流动力学、心肌肌钙蛋白Ⅰ(cTnⅠ)和肌酸激酶-同工酶(CK-MB)的影响。方法 选取2017年1月到2021年12月在郑州市第七人民医院接受心内直视手术的患者60例，根据随机数字表法，将患者分为对照组和研究组，各30例。对照组患者采用瑞芬太尼麻醉，而研究组患者采用右美托咪定联合瑞芬太尼麻醉，比较两组患者麻醉给药10 min后(T1)、切皮时(T2)、纵断胸骨时(T3)、体外循环(CPB)结束时(T4)和手术结束时(T5)心率和平均动脉压，比较两组患者手术结束时(T5)、体外循环(CPB)结束后12 h(T6)和体外循环(CPB)结束后24 h(T7)血浆cTnⅠ、CK-MB水平。结果 研究组患者麻醉效果良好率显著高于对照组患者(90。00％ vs 66。67％，P＜0。05)。研究组患者T1、T2、T3、T4和T5时间点心率和平均动脉压均显著低于对照组患者(P＜0。05)。两组患者在T5、T6和T7时间点研究组患者血浆cTnⅠ和CK-MB水平均显著低于对照组患者(P＜0。05)。结论 在心内直视手术中应用右美托咪定复合瑞芬太尼进行麻醉不仅可以取得较好的麻醉效果，而且保障患者在心肌缺血再灌注后血流动力学更稳定和心肌损伤更低。
Effects of dexmedetomidine combined with remifentanil on hemodynamics,troponin,creatine kinase-isoenzymes after myocardial ischemia-reperfusion in open heart surgery
Objective To study the effects of dexmedetomidine combined with remifentanil on hemodynamics,on hemo-dynamics,troponin Ⅰ(cTnⅠ)and creatine kinase-isoenzyme(CK-MB)after myocardial ischemia-reperfusion in open heart surgery.Methods Totally 60 patients undergoing open heart surgery in our hospital from January 2017 to December 2021 were selected,and divided into the control group and the study group,with 30 patients each.The pa-tients in the control group were anesthetized with remifentanil,while the patients in the research group were anesthetized with dexmedetomidine combined with remifentanil.The two groups of patients were compared 10 minutes after adminis-tration of anesthesia(T1),during skin incision(T2),and at the time of incision(T2).(T3),stop cardiopulmonary bypass(CPB)(T5)and at the end of surgery(T6)heart rate and mean arterial pressure,compare the two groups at T3,30 minutes after opening the artery(T6),12 hours after stopping CPB(T7)and Plasma cTnⅠ and CK-MB levels 24 hours after stopping CPB(T8).Results The rate of good anesthesia effect in the study group was significantly high-er than that in the control group(90.00％ vs 66.67％,P＜0.05).The heart rate and mean arterial pressure at T1,T2,T3,T4 and T5 time points in the study group were significantly lower than those in the control group(P＜0.05).There was no significant difference in plasma cTnⅠ and CK-MB levels between the two groups at time point T3(P＞0.05),but at time points T6,T7 and T8,the levels of plasma cTnⅠ and CK-MB in the study group were signifi-cantly lower than those in the control group(P＞0.05).Conclusion The application of dexmedetomidine combined with remifentanil for anesthesia in open heart surgery can not only achieve better anesthesia effect,but also ensure more stable hemodynamics and lower myocardial injury in patients after myocardial ischemia-reperfusion.
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