不同剂量右美托咪啶对非体外循环冠状动脉旁路移植术患者麻醉诱导期间血流动力学的影响  

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

作　　者：艾春雨[1] 江晓菁[1] 马虹[1] 王俊科[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：《中国医师进修杂志》2016年第2期105-108,共4页Chinese Journal of Postgraduates of Medicine

基　　金：辽宁省科学技术计划项目（2012225021）

摘　　要：目的评价不同剂量右美托咪啶对非体外循环冠状动脉旁路移植术患者麻醉诱导期间血流动力学的影响。方法拟行非体外循环冠状动脉旁路移植术患者60例，ASA分级Ⅱ- Ⅲ级，NYHA心功能分级Ⅱ-Ⅲ级，左室射血分数〉45%。将患者按随机数字表法分为D1组、D2组和对照组，每组20例。D1组麻醉诱导前持续静脉输注右美托咪啶0.3 μg/kg 20 min, D2组麻醉诱导前持续静脉输注右美托咪啶0.6 μg/kg 20 min，对照组麻醉诱导前给予等容量0.9%氯化钠。分别于泵注右美托咪啶前（T0）、麻醉诱导前（T1）、麻醉诱导后3 min （T2）、气管插管时（T3）及气管插管后5 min （T4）记录平均动脉压（MAP）、心率、心输出量、每搏量变异度（SVV）。观察麻醉诱导期间心血管不良事件的发生情况以及药物干预情况。结果三组T0 MAP、心率、心输出量、SVV比较差异无统计学意义（P〉0.05）。与对照组比较，D1组T1、T2、T3、T4时心率降低，D2组T1、T2、T3、T4时MAP、心率、心输出量、SVV均降低，差异有统计学意义（P〈0.05）；与本组T0比较，D1组T1、T2、T3、T4时心率降低，对照组T3时MAP、心率、心输出量、SVV明显增高，D2组T1、T2、T3、T4时MAP、心率、心输出量、SVV降低，差异有统计学意义（P〈0.05）；与D1组比较，D2组T2、T3、T4时MAP、心率、心输出量、SVV均降低，差异有统计学意义（P〈0.05）。D1组和D2组心血管不良事件发生率明显低于对照组［35%（7/20）和40%（8/20）比95%（19/20）]，D1组药物干预率明显低于对照组和D2组[10%（2/20）比45%（9/20）和35%（7/20）]，差异有统计学意义（P〈0.05）。结论麻醉诱导前给予右美托咪啶（0.3 μg/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流动力学。Objective To evaluate the effects of dexmedetomidine with different-dose on the hemodynamics during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting. Methods Sixty patients undergoing off-pump coronary artery bypass grafting were selected, with ASA grade II - III, NYHA cardiac functional grading II - III, and left ventricles ejection fraction 〉 45%. The patients were divided into D, group, D2 group and control group by table of random digit method with 20 cases each. In D, group, intravenous infusion dexmedetomidine 0.3 μg/kg was given for 20 rain before anesthesia induction; in D2 group, intravenous infusion dexmedetomidine 0.6μg/kg was given for 20 min before anesthesia induction; in control group, intravenous infusion the same volume of 0.9% sodium chloride was given before anesthesia induction. The mean arterial pressure （MAP）, heart rate, cardiac output and stroke volume variation （SVV） were recorded before infusion dexmedetomidine （T0）, before anesthesia induction （T1）, 3 min after anesthesia induction （T2）, trachea cannula （T3） and 5 min after trachea cannula （%）. The adverse cardiovascular events and drug intervention were recorded during anesthesia induction. Results There were no statistical differences in MAP, heart rate, cardiac output and SVV at To among 3 groups （P 〉 0.05）. Compared with that in control group, the heart rate at T1, T2, T3 and T4 in D1 group were decreased, the MAP, heart rate, cardiac output and SVV at T1, T2, T3 and T4 in D2 group were decreased, and there were statistical differences （P 〈 0.05）. Compared with that at To, the heart rate at T1, T2, T3 and T4 in D1 group were decreased, the MAP, heart rate, cardiac output and SVV at T3 in control group were increased, the MAP, heart rate, cardiac output and SVV at T1, T2, T3, T4 in D2 group were decreased, and there were statistical differences （P 〈 0.05）. Compared with that in D, group, the MAP, heart rate, cardiac output and SVV at T2, T3 and T4 i

关 键 词：右美托咪啶 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]