盐酸右美托咪定用于非体外循环冠状动脉旁路移植手术的心脏保护  

Myocardial Protection of Dexmedetomidine Hydrochloride During Off-pump Coronary Artery Bypass Graft Surgery

作　　者：吴志林[1] 褚淑娟[1] 王洁[1] 伍静[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉科,武汉430022

出　　处：《医药导报》2016年第3期268-271,共4页Herald of Medicine

摘　　要：目的观察合并使用盐酸右美托咪定对非体外循环冠状动脉旁路移植手术的心脏保护作用。方法将40例拟行冠状动脉旁路移植手术患者随机分为对照组(C组)和右美托咪定组(D组)各20例。D组麻醉诱导前给予盐酸右美托咪定0.5μg·kg-1负荷剂量,以0.5μg·kg^(-1)·h^(-1)持续输注,两组均采用靶控技术输注麻醉药物,以食道超声多普勒监测血容量和心功能,在严密监测下输液,补充血容量,维持循环稳定,每5 min记录有创血压和心率。于麻醉诱导后(t_0)、手术前(t_1)、术后结束后(t_2)、术后12 h(t_3)、术后24 h(t_4)抽取血标本检测cTnI、CK-MB和TNF-α、IL-6的含量。结果 D组患者切皮前(t_0、t_1)收缩压和心率均较C组术前显著下降,其他时间点差异无统计学意义。两组t_2、t_3、t_4血浆CK-MB、cTnI和TNF-α、IL-6均较t_0和t_1显著增高(P<0.05)。在t_2、t_3、t_4与C组相比显著降低(P<0.05),D组术后血管活性药物减少。结论盐酸右美托咪定可以降低非体外循环下冠状动脉旁路移植手术的炎症反应,减轻手术后的心肌损伤,改善术后患者心脏功能。Objective To investigate the myocardial protection effect of dexmedetomidine hydrochloride during off-pump coronary artery bypass graft surgery. Methods Forty patients undergoing off-pump coronary artery bypass grafting were randomly divided into two groups：control group （group C） and dexmedetomidine group （group D）.Dexmedetomidine hydrochlo-ride was given at a loading dose of 0. 5 μg-kg-1 to patients in group D, and then infused continuously at a rate of 0.5 μg-kg-1·h-1.The same amount of saline was given to patients in group C. After loading dosing,general anesthesia was per-formed with TCI technique.Trans-esophagus Doppler monitoring was conducted to monitor the blood volume and heart function, and close monitoring of fluid infusion to maintain stable circulation.Invasive blood pressure and heart rate were recorded every 5 min. Blood samples were taken for detection of cTnI,CK-MB,TNF-αand IL-6 contents at the following time points：after induction （ t0 ） ,before operation （ t1 ） ,after operation （ t2 ） ,12 h postoperation （ t3 ） and 24 h postoperation （ t4 ） . Results The blood pressure and heart rate decreased significantly at t0 and t1 in group D compared with group C,and there were no significant differ-ences in the two indexes at other time points between the two groups.Blood CK-MB,cTnI and inflammation factors TNF-α,IL-6 were much higher at t2,t3,t4 than at t0 and t1 in both groups（P〈0.05）.They were significantly decreased at t2,t3,t4 in group D relative to group C （P〈0.05）.Vessel active medicines were less given after the operation in group D （P〈0.05）. Conclusion Dexmedetomidine hydrochloride can mitigate the inflammation responses caused by off-pump coronary artery bypass grafting,re-duce the myocardial injury and improve the cardiac function of the patients.

关 键 词：右美托咪定 盐酸 手术 移植 冠状动脉旁路 心肌保护 

分 类 号：R971.2[医药卫生—药品] R542.2[医药卫生—药学]