氢吗啡酮对心脏病患者的心肌保护作用研究

Clinical observation of hydromorphone on myocardial protection in patients with heart disease

摘要:

目的 探讨氢吗啡酮预处理对无需行心脏手术的心脏病患者是否具有心肌保护的作用。 方法 选择无需行心脏手术的心脏病患者60 例，随机分成对照组和实验组。全身麻醉诱导前15 min，对照组 肌内注射生理盐水2 ml，实验组肌内注射氢吗啡酮2 ml。观察两组患者肌内注射即刻（T0）、插管前（T1）、 插管后（T2）、肌内注射后1 h（T3）及拔管后（T4）的血压、心率和心律失常情况。检测手术前和肌内注射 后6 和24 h 的血清磷酸肌酸激酶同工酶、肌钙蛋白I 及肌红蛋白的浓度。结果 两组患者收缩压（SBP）、 舒张压（DBP）比较，差异无统计学意义（P >0.05）；实验组心率低于对照组（P <0.05）；两组患者T0、T1、 T2、T3 时的心律失常发生率比较，差异无统计学意义（P >0.05），实验组T4 时心律失常发生率低于对照组 （P <0.05）；实验组肌内注射后6 和24 h 的血清磷酸肌酸激酶同工酶、肌红蛋白浓度及肌钙蛋白I 异常增高率 低于对照组（P <0.05）。结论 氢吗啡酮预处理对无需行心脏手术的心脏病患者有心肌保护作用。

Abstract:

Objective To investigate myocardial protection effect of hydromorphone protection effect on noncardiac surgery in patients with heart disease. Methods Totally 60 heart disease patients without cardiac surgery were randomly divided into control group and experimental group. The control group received intramuscular injection of 2ml of normal saline 15 minutes before induction of general anesthesia, while the experimental group received intramuscular injection of 2ml of hydromorphone. The blood pressure, heart rate and the change of arrhythmia in two groups were recorded before intramuscular injection (T0), before intubation (T1), after intubation (T2), 1 h after intramuscular injection (T3) and after extubation (T4). The concentration of serum creatine kinase isoenzyme, troponin I and myoglobin were detected before the operation, 6 h after intramuscular injection and 24 h after intramuscular injection. Results There was no difference between SBP and DBP (F high pressure=0.074, P = 0.787; F low pressure=1.280, P = 0.262); the heart rate in the experimental group was lower than that in the control group (F = 11.781, P = 0.001); there was no significant difference in the incidence of arrhythmia between the two groups immediately before intramuscular injection (T0), before intubation (T1), after intubation (T2) and 1 h after intramuscular injection (T3) (P > 0.05); the incidence of arrhythmia in the experimental group was lower than that in the control group after extubation (T4) (P < 0.05); the concentration of serum creatine kinase isoenzyme, troponin I and myoglobin in the experimental group were lower than those in the control group 6 h and 24 h after intramuscular injection, and the difference was statistically significant (P < 0.05). Conclusions Hydromorphone preconditioning has myocardial protection effect on heart disease patients without cardiac surgery.