不同剂量右美托咪定对体外循环下心脏瓣膜置换手术患者血流动力学的影响  

Effects of Different Doses of Dexmedetomidine on Hemodynamics in Patients Undergoing Cardiac Valve Replacement under Cardiopulmonary Bypass

作　　者：叶永科[1] YE Yong-ke(Department of Anesthesiology,Hanzhong Central Hospital,Hanzhong,Shaanxi 723000,China)

机构地区：[1]汉中市中心医院麻醉科,陕西汉中723000

出　　处：《解放军医药杂志》2017年第12期96-99,112,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：陕西省教育厅专项科研资助项目(15JK1627)

摘　　要：目的探讨不同剂量右美托咪定对体外循环(CPB)下心脏瓣膜置换手术患者血流动力学的影响。方法通过对2013年2月—2016年12月就诊治疗的120例风湿性心脏病行心脏瓣膜置换手术患者的临床资料做回顾性分析。并根据右美托咪定注射剂量的不同分为A、B和C组,每组40例。A组给予等量生理盐水,B组静脉注射右美托咪定0.5μg/kg,C组静脉注射右美托咪定1.0μg/kg。观察并比较3组用药前、CPB停止10 min前、手术结束时、术后8和24 h的心肌损伤标志物水平,以及用药前(T0)、用右美托咪定时(T1)、切皮后(T2)、劈胸骨后(T3)、CBP前(T4)、CBP停止后10 min(T5)的血流动力学指标水平。观察3组不良反应及并发症情况。结果 CPB停止10 min前、手术结束时、术后8和24 h,B和C组肌钙蛋白-I、心型脂肪酸结合蛋白、肌酸激酶同工酶水平均低于A组,且B组低于C组(P<0.05)。T1~T4时,B和C组心率均低于A组,且C组低与B组(P<0.05)。T1~T5时,B和C组平均动脉压均高于A组(P<0.05)。3组麻醉不良反应发生率比较差异有统计学意义(P<0.05)。结论对CPB下心脏瓣膜置换手术患者麻醉诱导后,静脉注射右美托咪定0.5μg/kg可最大程度的减轻患者的心肌损伤,同时维持血流动力学稳定,且安全可靠。Objective To investigate effect of different doses of Dexmedetomidine on hemodynamics in patients undergoing cardiac valve replacement under cardiopulmonary bypass(CPB).Methods Clinical data of120patients with rheumatic heart disease,who had undergone cardiac valve replacement during February2013and December2016,was retrospectively analyzed,and the patients were divided into group A,B,and C according to different doses of Dexmedetomidine(n=40for each group).Group A was given the same volume of normal saline,and group B was treated with0.5μg/kg Dexmedetomidine by intravenous injection,and group C was treated with1.0μg/kg Dexmedetomidine by intravenous injection.Levels of myocardial injury markers before medication,at10min before CPB stopping,at the end of surgery,at8and24h after operation,and levels of hemodynamic parameters before medication(T0),at the time of using Dexmedetomidine(T1),after cutting skin(T2),after rending sternum(T3),before CBP(T4)and at10min after CBP stopping(T5)were observed and compared in3groups.Conditions of adverse reactions and complications were observed in3groups.Results At10min before CPB stopping,at the end of surgery,at8and24h after operation,levels of troponin-I,heart type fatty acid binding protein and creatine kinase isoenzyme in group B and C were significantly lower than those in group A,and the levels in group B were significantly lower than those in group C(P<0.05).At T1-T4,heart rates in group B and C were significantly lower than those in group A,and the rates in group C were significantly lower than those in group B(P<0.05).At T1-T5,values of the mean arterial pressure in group B and C were significantly higher than those in group A(P<0.05).There were significant differences in incidence rate of anesthetic adverse reactions among3groups(P<0.05).Conclusion Intravenous infusion of0.5μg/kg Dexmedetomidine can maximally reduce myocardial injury and maintain the stability of hemodynamics simultaneously with safety in patients undergoing cardiac valve replacement under CPB aft

关 键 词：右美托咪定 体外循环 心脏瓣膜置换手术 血流动力学 

分 类 号：R614[医药卫生—麻醉学] R654.2[医药卫生—外科学]