右美托咪定和七氟醚改善冠心病非心脏手术患者围术期心肌缺血的比较  

Comparison of dexmedetomidine versus sevoflurane to reduce perioperative myocardial ischemia in coronary heart disease patients undergoing noncardiac surgery

作　　者：张继如[1,2] 陈敏[3] 王志强[4] 董楠[2] 俞卫锋[5] 

机构地区：[1]苏州大学临床医学院,215006 [2]江南大学附属医院无锡市第四人民医院麻醉科 [3]江南大学附属医院无锡市第四人民医院检验科 [4]江南大学附属医院无锡市第四人民医院胸外科 [5]第二军医大学附属东方肝胆外科医院

出　　处：《临床麻醉学杂志》2017年第3期273-276,共4页Journal of Clinical Anesthesiology

基　　金：无锡市卫生和计划生育委员会(MS201517);无锡市医院管理中心课题(YGZXY1307)

摘　　要：目的观察和比较右美托咪定和七氟醚对冠心病非心脏手术患者围术期心肌保护的效应。方法选择择期合并冠心病的腔镜下胸腹部手术患者135例,男90例,女45例,年龄45~82岁,ASAⅡ或Ⅲ级。采用随机数字表法将患者分为三组:对照组(C组),右美托咪定组(D组)和七氟醚组(S组),每组45例。采用依托咪酯0.2mg/kg、丙泊酚0.5mg/kg、顺苯磺酸阿曲库铵0.2~0.3mg/kg和芬太尼5.0~6.0μg/kg进行麻醉诱导和维持,D组诱导前10min开始至手术结束持续泵注右美托咪定。C组给予等容量生理盐水。S组从麻醉诱导后开始持续吸入七氟醚至手术结束前30min停用。记录术中和术后72h内心肌缺血的发生情况。结果术中C组心肌缺血的发生率[12例(26.7%)]明显高于D组[3例(6.7%)]和S组[4例(8.9%)](P<0.05);术后72h内C组、D组和S组心肌缺血的发生率分别为6例(13.3%)、4例(8.9%)和4例(8.9%),差异无统计学意义。结论右美托咪定和七氟醚均能通过改善心肌血氧供需平衡,降低冠心病非心脏手术患者心肌缺血的发生率。Objective To investigate the effect of dexmedetomidine versus sevoflurane to perioperative myocardial ischemia in coronary heart disease patients undergoing noncardiac surgery.Methods A total of 135 patients （90 males,45 females,aged 45-82 years,ASA grade Ⅱ or Ⅲ） with coronary heart disease,undergoing endoscopic thoracic and abdominal surgery,were divided into control group （group C）,dexmedetomidine group （group D） and sevoflurane group （group S） by random number table.Anesthesia induction and maintenance were adopted by etomidate 0.2 mg/kg,propofol 0.5 mg/kg,atracuronium sulfonate 0.2-0.3 mg/kg and fentanyl 5.0-6.0 μg/kg.Dexmedetomidine was given the continuous injection from 10 min before the start of the operation to the end in group D.Equal volume of saline was given in group C.Sevoflurane was inhaled from the induction of anesthesia 30 min before the end of surgery.ST segment changes of electrocardiogram were recorded for diagnosis of myocardial ischemia during the operation and postoperative 72 hours.Results The incidence of myocardial ischemia in group C,group D and group S were 26.7% （12 cases）,6.7% （3 cases）,8.9% （4 cases） during the operation and 13.3% （6 cases）,8.9% （4 cases） and 8.9% （4 cases） postoperative 72 hours.Conclusion Dexmedetomidine and sevoflurane can improve the balance of blood oxygen supply and demand to reduce cardiovascular complications of non-cardiac surgery in patients with coronary heart disease.

关 键 词：右美托咪定 七氟醚 冠心病 非心脏手术 

分 类 号：R614[医药卫生—麻醉学]