The Protective Effect Of Different Doses Of Dexmedetomidine On The Myocardium In Patients With Coronary Heart Disease In Non-cardiac Surgery

BackgroundCoronary heart disease（CHD）is a heart disease in which atherosclerosis of coronary arteries causes vascular lumen stenosis and myocardial ischemia and hypoxia.With the increase in the incidence of coronary heart disease,more and more patients with coronary heart disease are undergoing non-cardiac surgical opertion.Dexmedetomidine（Dex）is anα₂-adrenergic receptor agonist with sedative,analgesic,and anti-sympathetic effects.It has a certain protective effect on ischemic myocardium.PurposeOur research investigate the application of the optimal dose of dexmedetomidine by observing the effects of different doses of dexmedetomidine on perioperative heart rate（HR）,mean arterial pressure（MAP）,myocardial markers and inflammatory factors in patients with coronary heart disease undergoing non-cardiac surgery.MethodsSelect 80 patients with coronary heart disease who are planning to undergo elective laparoscopic gastrointestinal surgery in our hospital,and divide them into control group（group C）and 0.5μg/kg dexmedetomidine group（group D1）,0.75μg/kg dexmedeto Midine group（group D2）,1.0μg/kg dexmedetomidine（group D3）.group D1,group D2,and group D3 were pumped with dexmedetomidine 0.5μg/kg,0.75μg/kg,1.0μg/kg 10 min before induction of anesthesia,and group C was pumped with 0.9%sodium chloride injection of equal volume.Record the patient’s HR and MAP at the 5 time points 15min before induction of anesthesia（Ta₁）,immediately after endotracheal intubation（Ta₂）,start of operation（Ta₃）,end of operation（Ta₄）,and immediately after extubation（Ta₅）;collect anesthesia induction The venous blood of patients at four time points:the first 15 minutes（Tb₁）,the end of the operation（Tb₂）,the 24 hours after the operation（Tb₃）,and the 48hours after the operation（Tb₄）,the serum tumor necrosis factor-α（tumor necrosis factor-α,TNF-α）,interleukin-6（IL-6）,serum troponin I（cardiac troponin I,c Tn I）,creatine kinase-MB（CK-MB）,N-terminal pro-B-type natriuretic peptide（NT-Pro BNP）level;record the number of adverse reactions such as hypotension,bradycardia,hypertension,and tachycardia during the operation.Results1.The total amount of dexmedetomidine used in the four groups of patients was different（P<0.05）.2.Compared with group C,at the time of Ta₂,Ta₃,and Ta₅,the mean arterial pressure and heart rate of group D1,group D2,and group D3 were lower than those of group C （P<0.05）;compared with group D1,At Ta₄,the mean arterial pressure and heart rate of the group D3 were lower than those of the group D1（P<0.05）.3.Intra-group comparison:at the time of Tb₂、Tb₃,the levels of TNF-αand IL-6 in the four groups were higher than the time of Tb₁（P<0.05）;comparison between groups;At the time of Tb₂,the levels of TNF-αand IL-6 in the group D3 were lower than those in the group C and group D1（P<0.05）.4.Intra-group comparison:at the time of Tb₂、Tb₃、Tb₄,the levels of c Tn I,CK-MB,and NT-Pro BNP in the four groups were higher than the time of Tb₁（P<0.05）;comparison between the groups,at the time of Tb₃,the levels of cTnI,CK-MB,NT-ProBNP of the patients in the group D1 were lower than those in the group C,group D2,and group D3（P<0.05）.5.Compared with group C,the incidence of hypotension and bradycardia in group D3was higher than that in group C（P<0.05）;compared with group D1,the incidence of hypotension in group D3 was higher than the group D1（P<0.05）.ConclusionThe application of 0.5μg/kg dexmedetomidine in laparoscopic gastrointestinal surgery has a good protective effect on the myocardium of patients with coronary heart disease.