右美托咪定用于非体外循环冠状动脉移植术患者的临床观察  

Clinical Observation on Dexmedetomidine in Patients with Off-pump Coronary Artery Bypass Grafting

作　　者：周泓旭[1] 虞建刚[1] 方波[1] 马虹[1] 

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中国医科大学学报》2015年第4期332-337,共6页Journal of China Medical University

摘　　要：目的观察右美托咪定用于非体外循环冠状动脉移植术患者的疗效和安全性,为今后指导临床用药提供参考依据。方法选取择期行非体外循环冠状动脉移植术患者(ASA分级Ⅱ或Ⅲ级)30例,随机分为对照组和观察组,每组15例。在麻醉诱导前1 h,观察组静脉泵注右美托咪定(DEX)0.5μg/kg,泵注时间为30 min;对照组以同样方法泵注等剂量生理盐水。观察平均动脉压(MAP)、心率(HR)、心输出量(CO)、中心静脉压(CVP)、双频谱指数(BIS)以及麻醉维持期间芬太尼、七氟烷、血管活性药(去甲肾上腺素、去氧肾上腺素、硝酸甘油)用量,同时记录两组患者的输液量、出血量和尿量。观察记录点为给药前(T0)、给药后即刻(T1)、给药后5 min(T2)、给药后10 min(T3)、给药后20 min(T4)、麻醉诱导前(T5)、气管插管前(T6)、插管后即刻(T7)、插管后1 min(T8)、插管后3 min(T9)、插管后5 min(T10)、切皮时(T11)和开胸时(T12)。结果 (1)DEX对诱导前血流动力学的影响:观察组患者MAP、HR、CO在T1、T2、T3、T4、T5时比T0时显著降低(P<0.05);对照组患者MAP、HR在T1、T2时比T0时显著升高(P<0.05);与对照组比较,观察组MAP、HR、CO在T1、T2、T3、T4、T5时显著降低(P<0.05)。(2)DEX对诱导后血流动力学的影响:观察组MAP、HR在T7、T8、T9、T10时与T6时比较没有明显差异(P>0.05);对照组MAP、HR在T7、T8、T9、T10时比T6时显著升高(P<0.05);观察组MAP、HR在T7、T8、T9、T10、T11、T12时比对照组显著降低(P<0.05);观察组CO在T6、T7、T8、T9、T10、T11、T12时较对照组显著降低(P<0.05)。(3)DEX对BIS值的影响:与T0比较,观察组T1、T2、T3、T4、T5时的BIS值下降(P<0.05)。T1、T2、T3、T4、T5时观察组BIS值较对照组显著降低(P<0.05)。(4)DEX对麻醉维持期间药物用量2组比较的影响:与对照组比较,观察组七氟烷、芬太尼用量显著减少,而去甲肾上腺素、去氧肾上腺素用量显著增加(P<0.05),而硝酸�ObjectiveTo observe the efficacy and safety of dexmedetomidine in patients with off- pump coronary artery bypass grafting（OP-CABG）,in order to provide some references for clinical drug use in the future.MethodsThirty patients undergoing OPCABG[American societyanesthesiologists（ASA）gradeⅡorⅢ],were randomly divided into the observation group and the control group,each group with 15 cases. In the ob-servation group,0.5 μg/kg dexmedetomidine（DEX）was administered intravenously in 30 minutes before induction of anesthesia;while in the con-trol group,the same dose of 0.9% normal saline was given in the same way. The mean arterial pressure（MAP）,heart rate（HR）,cardiac output（CO）,central venous pressure（CVP）,and BIS were monitored during the procedure. The dosages of fentanyl,sevoflurane and vasoactive drugs（norepinephrine,phenylephrine,nitroglycerin）,infusion volume,amount of bleeding and urinary volume were recorded during maintenance of an-aesthesia. The observation times were before administration infusion（T0）,after administration immediately（T1）,5 min after administration（T2）,10 min after administration（T3）,20 min after administration（T4）,before induction of anesthesia（T5）,before tracheal intubation（T6）,immedi-ately after intubation（T7）,1 min after intubation（T8）,3 min after intubation（T9）,5 min after intubation（T10）,skin incision（T11）,thoracoto-my（T12）.ResultsThe effect on hemodynamics before the induction：MAP,HR and CO decreased significantly at T1,T2,T3,T4,T5 comparedwith T0 in the observation group（P〈0.05）;MAP and HR increased significantly at T1,T2 compared with T0 in the control group（P〈0.05）;MAP,HR and CO in the observation group were significantly lower than the control group at T1,T2,T3,T4,T5（P〈0.05）. The effect on hemodynamics after the induction：MAP,HR at T7,T8,T9,T10 were no significant difference from T6 in the observation group（P〈0.05）;MAP,HR in-creased significantly at T7,T8,T9,T10 compar

关 键 词：右美托咪定 非体外循环冠状动脉移植术 血流动力学 双频谱指数 

分 类 号：R614.2[医药卫生—麻醉学]