不同剂量右美托咪定对冠状动脉旁路移植术前频发心绞痛患者吗啡用量的影响  

Effects of different doses of Dexmedetomidine on Morphine consumption in patients with frequent angina before coronary artery bypass grafting

作　　者：王园园[1] 呼海娟[2] 柳磊[1] 李滨[1] 李召彬[1] WANG Yuanyuan;HU Haijuan;LIU Lei;LI Bin;LI Zhaobin(Department of Cardiac Surgery,the Third Hospital of Hebei Medical University,Hebei Province,Shijiazhuang,050051,China;Department of Cardiovascular,the Second Hospital of Hebei Medical University,Hebei Provincial Cardiovascular Research Institute,Hebei Province,Shijiazhuang,050051,China)

机构地区：[1]河北医科大学第三医院心外科,河北石家庄050051 [2]河北医科大学第二医院心内科河北省心血管病研究所,河北石家庄050051

出　　处：《中国医药导报》2018年第31期94-98,共5页China Medical Herald

基　　金：河北省医学科学研究重点课题计划(20180467)

摘　　要：目的探讨不同剂量右美托咪定(Dex)对冠状动脉旁路移植术前频发心绞痛患者吗啡用量的影响。方法选择2016年1月～2018年1月河北医科大学第三医院择期行冠状动脉旁路移植术的患者100例。采用随机数字表法将其分为C组和Dex组(Dex 1组、Dex 2组、Dex 3组),每组各25例。C组心绞痛发作时给予0.1 mg/kg负荷量吗啡静脉注射,Dex组给予不同剂量右美托咪定持续泵入[Dex 1组0.2μg/(kg·h),Dex 2组0.5μg/(kg·h),Dex 3组0.7μg/(kg·h)],在该基础上依据患者心绞痛发作情况分次给予0.1 mg/kg负荷量吗啡静脉注射;记录各组患者用药前(T_0)及用药后1 h(T_1)、3 h(T_2)、6 h(T_3)、12 h(T_4)、24 h(T_5)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO_2)、心绞痛发作总次数、吗啡累计用量、镇静评分情况。结果 Dex各组T_2～T_5时间点的HR、吗啡累计用量、心绞痛发作次数低于C组(P <0.05)。T_0～T_5时间点,各组MAP、呼吸频率、SpO_2比较,差异无统计学意义(P>0.05);Dex 3组患者T_2～T_5时间点的HR、吗啡累积用量、心绞痛发作次数明显少于Dex 1组(P <0.05),Dex 1和Dex 2组差异无统计学意义(P> 0.05);T_2～T_5时间点Dex 3组的镇静评分显著高于Dex 1组和Dex 2组(P <0.05)。结论冠状动脉旁路移植术前针对频发心绞痛的患者持续泵入小剂量右美托咪定[0.2μg/(kg·h)]即能有效控制心绞痛发作。Objective To investigate the effect of different doses of Dexmedetomidine （Dex） on Morphine consumption in patients with frequent angina before coronary artery bypass grafting. Methods A total of 100 patients undergoing coronary artery bypass grafting in the Third Hospital of Hebei Medical University from January 2016 to January 2018 were selected. They were divided into group C, Dex 1 group, Dex 2 group, Dex 3 group, by random number table method, 25 cases in each group. The group C was given the 0.1 mg/kg load of Morphine intravenously at the time of angina pectoris; the Dex group was treated with different doses of Dex [Dex 1 group with 0.2 μg/（kg·h）, Dex 2 group with 0.5 μg/（kg·h）, Dex 3 group with 0.7 μg/（kg·h）], and on the basis of the patients′ angina pectoris condition, the amount of 0.1 mg/kg load was given. Intravenous injection of morphine. Before （T0） and 1 h （T1）, 3 h （T2）, 6 h （T3）, 12 h （T4）, 24 h （T5） after the heart rate （HR）, mean arterial pressure （MAP）, pulse oxygen saturation （SpO2）, total frequency of angina pectoris, Morphine dosage and Ramsay score were recorded. Results The HR at T2-T5, Morphine dosage, and frequency of angina pectoris of Dex group were lower than group C （P 〈 0.05）. From T0 to T5, MAP, RR, SpO2 in each groups had no statistically significant difference （P 〉 0.05）, HR at T2-T5, Morphine dosage, frequency of angina pectoris of Dex 3 group were lower than Dex 1 group （P 〈 0.05）, but, there was no difference between Dex 1 group and Dex 2 group （P 〉 0.05）. From T2 to T5, Ramsay score of Dex 3 group was higher than Dex 1 group and Dex 2 group significantly （P 〈 0.05）. Conclusion Continuous administration of a small dose of Dex [0.2 μg/（kg·h）] to patierts with frequent angia before coronary artery bypass grafting can effectinely control the onset of angina pectories.

关 键 词：右美托咪定 吗啡 冠状动脉旁路移植术 心绞痛 

分 类 号：R541.4[医药卫生—心血管疾病]