右美托咪啶复合小剂量舒芬太尼对非体外循环冠状动脉旁路移植术患者麻醉诱导期间血液动力学的影响  

Effects of dexmedetomidine conmbined with small-dose of sulfentanil on hemodynamics during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting

作　　者：江岩[1] 王世端[1] 刘爱杰[1] 滕如阳[1] 孙健[1] 刘文义[1] 初春芹[1] 

机构地区：[1]青岛大学医学院附属医院麻醉科,266003

出　　处：《中华麻醉学杂志》2011年第9期1093-1095,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价右美托咪啶复合小剂量舒芬太尼对非体外循环冠状动脉旁路移植术患者麻醉诱导期间血液动力学的影响。方法拟行非体外循环冠状动脉旁路移植术患者75例，性别不限，年龄46～72岁，体重59～86kg，ASA分级Ⅱ级或Ⅲ级，NYHA心功能分级Ⅱ级或Ⅲ级，左室射血分数≥45％。采用随机数字表法，将患者随机分为3组（n=25）：右美托咪啶复合小剂量舒芬太尼组（DS组）、小剂量舒芬太尼组（S1组）和大剂量舒芬太尼组（S2组）。Ds组以60ml／h的速率静脉输注右美托咪啶0．8μg／kg（溶于15ml生理盐水中）15min；S1组和S2组给予等容量生理盐水。麻醉诱导：静脉注射咪达唑仑0．08mg／kg和哌库溴铵0．12mg／kg；在静脉注射总量1／3的咪达唑仑和总量1／8的哌库溴铵后，DS组、S1组和S2组分别静脉注射舒芬太尼0．5、0．5和0．8μg／kg（用生理盐水稀释至10m1），再静脉注射余量的咪达唑仑；当BIS值≤75时，静脉注射余量哌库溴铵；当BIS值≤55时行气管插管，机械通气，维持PETCO：30～35mmHg。记录麻醉诱导期间心血管不良事件的发生情况以及药物干预的情况。结果与S2组比较，S1组高血压和心动过速的发生率升高，S1组和DS组低血压发生率降低，DS组药物干预率降低（P〈0．05）；与S1组比较，DS组高血压、低血压和心动过度的发生率降低，心动过缓发生率升高，药物干预率降低（P〈0．05）。结论右美托咪啶（0．8μg／kg）复合较小剂量舒芬太尼（O．5μg／kg）有利于稳定非体外循环冠状动脉旁路移植术患者麻醉诱导期间的血液动力学。Objective To investgate the effects of dexmedetomidine combined with small-dose of sufentanil on the hemodynamics during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting. Methods Seventy-five ASA Ⅱ or Ⅱ and NYHA Ⅱ orⅢ patients aged 46-72 yr, weighing 59-86 kg, ejection fraction ≥ 45 %, undergoing off-pump coronary artery bypass grafting, were randomly divided into 3 groups （n = 25 ） ： dexmedetomidine combined with small-dose of sufentanil group （group DS）, small-dose of sufentanil group （group Sl ） and large-dose of sufentanil group （group S2 ）. In group DS, dexmedetomidine 0.8 μg/kg （diluted with normal saline to 15 ml） was injected for 15 min at a rate of 60 ml/h, while the same volume of normal saline were given in groups S1 and S2. Anesthesia was induced with midazolam 0.08 mg/kg and pipecuronium 0.12 mg/kg. After administration of the total dose of 1/3 midazolam and 1/8 pipecuronium, sufentanil 0.5, 0.5 and 0.8 μg/kg （diluted with narmalsaline to 10 ml） were injected in groups DS, S1 and S2 respectively. Then the rest of midazolam was injected. When BIS value ≤ 75, the rest of pipecuronium was injected. When BIS value ≤ 55, the patients were tracheal intubated and mechanically ventilated. PETCO2 was maintained at 30-35 mm Hg. The adverse ardiovascular events （hypertension, hypotension, tachycardia and bradycardia） and drugs intervention were recorded during anesthesia induction. Results Compared with group S2, the incidence of hypertension and tachycardia was significantly increased in group Sl , the incidence of hypotension decreased in groups Sl and DS, the incidence of drug intervention decreased in group DS （ P 〈 0.05）. Compared with group S1 , the incidence of hypertension, hypotension and tachycardia was significantly decreased, the incidence of bradycardia increased, theincidence of drug intervention decreased in group DS （P 〈 0.05）. Conclusion Dexmedetomidine （0.8 μg/kg） combined with small-dose of sufe

关 键 词：右美托咪啶 舒芬太尼 冠状动脉旁路移植术 非体外循环 血流动力学 

分 类 号：R614[医药卫生—麻醉学]