右美托咪定对非体外循环冠状动脉旁路移植术患者血流动力学及应激反应的影响  

Effect of dexmedetomidine on hemodynamics and stress reaction in patients undergoing off-pump coronary artery bypass grafting

作　　者：张子斌[1] 高成杰[1] 王瑞雯[1] 王惠霞[1] 徐鲁峰[1] 

机构地区：[1]解放军济南军区总医院麻醉科,250031

出　　处：《国际麻醉学与复苏杂志》2015年第8期673-677,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨右美托咪定（dexmedetomidine，Dex）持续输注对非体外循环冠状动脉旁路移植术（off-pumpcorona±ryarterybypassgrafting，0PCABG）患者血流动力学及应激反应的影响。方法择期行OPCABG患者60例，年龄45岁-65岁，体重55kg-85kg，美国麻醉医师协会（ASA）分级Ⅱ或Ⅲ级，采用随机数字表法分为Dex组（D组）和对照组（C组），每组30例。D组于麻醉诱导前静脉泵注负荷剂量的Dex0．5μg／kg，10min泵注完成后随即在麻醉诱导的同时以0．5μg·kg-1．h-1的速率泵注至术毕；C组以同样的方式泵注等量生理盐水。分别于泵注药物前（T0）、泵注完负荷量药物即刻（T1）、气管插管时（T2）、锯胸骨时（T3）、吻合前降支时（T4）、吻合右冠状动脉或后降支时（L）、吻合回旋支或对角支时（T6）、吻合近端时（T7）、吻合血管完毕后10min（T8）、手术结束时（T9）、拔出气管导管时（T10）记录各项血流动力学参数，并记录术中窦性心动过缓、窦性心动过速、低血压和高血压的发生次数以评价循环稳定性。分别于T0、T3、T8、T9、T10时检测血糖（glucose，Glu）、皮质醇（cortisol，Cor）、去甲肾上腺素（noradrenaline，NE）、肾上腺素（epinephrine，E）浓度，并记录术中芬太尼用量。结果与T0时比较，C组T2～Ts、T10时心率（heartrate，HR）明显增快（P〈0．05）；T2、T3、T10时平均动脉压mean arterial pressure，MAP）明显升高，而T4～T7时MAP明显降低（P〈0．05）；T3～R时平均肺动脉压mean pulmonary artery pressure，MPAP）、肺循环阻力指数（pulmonaryvascularresistanceindex，PVRI）、体循环阻力指数（systemvascularresistanceindex，SVRI）明显升高（P〈0．05）。与C组比较，D组T1-T10时HR明显减慢（P〈0．05），T1-T3、T9、T10时MAP明显降低（P〈0．05）；而T4～B时两组MAP差异无统计学意义（P〉0．05）；T1-T10时PVRI、SVRI明显降低�Objective To evaluate the effect of dexmedetomidine on hemodynamic and stress reaction in patients undergoing off-pump coronary artery bypass grafting （OPCABG）. Methods Sixty patients, ASA Ⅱ or Ⅲ , aged 45 y-65 y, weighting 55 kg-86 kg, scheduled for OPCABG, were randomly assigned to two groups： the group dexmedetomidine （group D, n= 30） and the group control （group C, n=30）. Patients in group D received an initial bolus dose of dexmedetomidine （0.5 μg/kg） over 10 min before anesthesia induction followed by a continuous infusion of 0.5μg·kg-1·h-1 until the end of the operation. Group C received equal volume of normal saline. Hemodynamic parameters were recorded before injection （T0）, after initial bolus dose infusion （T1）, when tracheal intubation （T2）, stemotomy （T3）, at anastomosis of left anterior descending （T4）, at anastomosis of right coronary artery or posterior descending artery （T5）, at anastomosis of left circumflex cornary artery or diagonal artery （T6）, at anastomosis of aortic （T7）, at 10 min after reestablishment of coronary blood flow （T8）, end of operation （T9） and after tracheal extubation （T10）. The stability of circulation was evaluated and consumption of fentany in both groups was recorded. Concentrations of blood glucose, cortisol, norepinephrine and epinephrine were measured at To, T3, Ts-Tlo. Results There was significant difference between group D and group C in heart rate （HR） at Ti-Txo, mean arterial pressure （MAP） at T1-T3,T9,T10,mean pulmonary artery pressure （MPAP） at T1-T3,T9,T10, system vascular resistance index （SVRI） at T1-T10, pulmonary vascular resistance index （PVRI） at T1-T10, cardiac index （CI） at T7-T8, left ventricular stroke work index （LVSWI） and right ventricular stroke work index （RVSWI）at T7-T8 （P〈0.05）. The incidences of sinus tachycardia and hypertension in group D were significantly reduced than in group C （P〈0.05）. In both groups, glucose （Glu）, cor

关 键 词：右美托咪定 非体外循环冠状旁路移植术 血流动力学 应激反应 

分 类 号：R614[医药卫生—麻醉学]