Protective Effect Of Dexmedetomidine On Myocardium During Off-pump Coronary Artery Bypass Grafting

BackgroundOff-pump coronary artery bypass grafting?OPCABG?is considered to be one of the most common and effective methods for the treatment of coronary heart disease,but many patients will have different degrees of myocardial damage,which will prolong the recovery time,hospitalization time,increase hospitalization costs,and death.The rate,therefore,reduces myocardial damage in patients with OPCABG as a focus of academic attention.Dexmedetomidine is a novel and highly selective?₂ adrenergic receptor agonist that has been clinically found to inhibit the release of stress hormones and reduce the release of stress hormones such as catechol by inhibiting the excitability of sympathetic nerves.The amount increases the excitability of the vagus nerve,thereby protecting the myocardium and preventing and alleviating myocardial damage.Studies have found that the application of dexmedetomidine in OPCABG can also play a role in myocardial protection,but the relevant research data is less,and relatively single,low confidence,whether there is myocardial protection for dexmedetomidine for OPCABG The effect and effect are not clear.ObjectiveTo observe whether dexmedetomidine has protective effect on myocardium in OPCABG,and to analyze the relationship between myocardial injury and inflammation,so as to provide reference for clinical application of dexmedetomidine in OPCABG.MethodsSixty patients with coronary heart disease who underwent elective OPCABG in our hospital from January 2019 to December 2019 were selected as subjects.They were divided into experimental group and control group according to the digital table method,30 cases each.From 15 minutes before anesthesia induction to immediately after tracheal intubation,the dexmedetomidine of 0.5·?g·kg-1·h-1 was intravenously injected into the experimental group,and the same dose of normal saline was given to the control group.Perioperative index?propofol use,ICU stay time,graft number,length of hospital stay?,vital signs?heart rate HR,mean arterial pressure MAP,pulse oximetry?The change of saturation SpO2,on the basis of this,compared the two groups of patients 15 minutes before anesthesia induction?T₀?,immediately after the skin?T₁?,immediately after the chest?T₂?,before the bridge?T₃?,after the bridge?T₄?,postoperative Troponin I?cTnI?,creatine kinase isoenzyme MB?CK-MB?,tumor necrosis factor-??TNF-??,interleukin-4hours?T₅?,24 hours after surgery?T₆?1??IL-1??,IL-6,IL-10,and the correlation between myocardial injury markers and inflammatory factor markers were analyzed,and the myocardial protection of dexmedetomidine in OPCABG was evaluated.Results1.The ICU stay time and hospitalization time of the experimental group were shorter than those of the control group,and the amount of propofol used was lower than that of the control group.The difference was statistically significant?P<0.05?.2.There was no significant change in HR,MAP,and SpO2 levels at T₀^T₆ in the experimental group.There was no significant difference between T₀ and T₆ at the time of T₀?P>0.05?,while the control group had all the indicators.Abnormal changes were observed.The HR level at T₂ and T₃ was significantly lower than that at T₀?P<0.05?.The MAP and SpO2 levels at T₂^T₄ were significantly lower than those at T₀?P<0.05?.Compared with the control group?P<0.05?,the HR and SpO₂ levels at T₂^T₄ were significantly higher than those in the control group?P<0.05?.3.At the time of T₀^T₅,the levels of cTnI increased in both groups,and the levels of cTnI decreased in both groups at time T₆.In the group,the cTnI levels of T₁^T₆ at any time were significantly higher than those at T₀?P<0.05?.The cTnI levels at the time of T₁^T₆ in the experimental group were significantly lower than those in the control group?P<0.05?.4.At the time of T₀^T₃,there was no significant change in CK-MB level between the two groups.At the time of T₄^T₆,the levels of CK-MB increased in both groups.In the group,the CK-MB levels at T₄^T₆ were significantly higher than those at T₀?P<0.05?.The CK-MB levels in the experimental group at T₄^T₆ were significantly lower than those in the control group?P<0.05?.5.TNF-?,IL-1?and IL-6 increased in the two groups at the time of T₀^T₃,and decreased at the time of T₄^T₆.In the group,TNF-?and IL-at any time of T₁^T₆ in the two groups were compared.1?and IL-6 levels were significantly higher than T₀?P<0.05?.Compared with the control group,the levels of TNF-?,IL-1?and IL-6 in the experimental group were significantly lower than those in the control group?P<0.05?.6.At the time of T₀^T₆,the IL-10 levels of the two groups continued to rise.In the group,the IL-10 levels of T₁^T₆ at any time were significantly higher than those at T₀?P<0.05?.The IL-10 levels at the time of T1^T6 in the experimental group were significantly higher than those in the control group?P<0.05?.ConclusionThe application of dexmedetomidine in OPCABG can reduce myocardial damage,protect the myocardium,and enhance myocardial protection by inhibiting inflammatory response while optimizing perioperative indicators and ensuring the stability of vital signs.