右美托咪定对行非体外循环冠状动脉旁路移植术的冠心病患者远期预后的影响研究  

Impact of Dexmedetomidine on Long-term Prognosis in Coronary Heart Disease Patients Underwent Off-pump Coronary Artery Bypass Grafting

作　　者：任建军[1] 黄立宁[1] 刘海涛[1] 刘悦[1] 董振明[1] REN Jian-jun;HUANG Li-ning;LIU Hai-tao;LIU Yue;DONG Zhen-ming(Department of Anesthesiology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院麻醉科,河北省石家庄市050000

出　　处：《实用心脑肺血管病杂志》2018年第2期24-27,33,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：河北省卫生和计划生育委员会重点科技研究计划课题(20130189)

摘　　要：目的探讨右美托咪定对行非体外循环冠状动脉旁路移植术(OPCABG)的冠心病患者远期预后的影响。方法选取2010年1月—2012年1月在河北医科大学第二医院行OPCABG的冠心病患者162例,随机分为C组和Dex组,每组81例。C组患者于第1支移植血管吻合结束后静脉滴注0.9%氯化钠溶液并持续至手术结束,转至心外科ICU后给予异丙酚镇静12 h;Dex组患者于第1支移植血管吻合结束后静脉滴注右美托咪定并持续至手术结束,转至心外科ICU后继续给予右美托咪定镇静12 h。比较两组患者穿刺完毕后5 min(T_0)、手术结束即刻(T_1)、术后12 h(T_2)、术后24 h(T_3)、术后48 h(T_4)、术后72 h(T_5)收缩压和心率,术后心律失常发生率及术后1年、3年死亡情况。结果时间与方法在收缩压上存在交互作用(P<0.05);时间在收缩压上主效应显著(P<0.05);方法在收缩压上主效应显著(P<0.05)。时间与方法在心率上无交互作用(P>0.05);时间在心率上主效应不显著(P>0.05);方法在心率上主效应显著(P<0.05)。T_1和T_2时,Dex组患者收缩压和心率低于C组(P<0.05)。两组患者术后心房颤动、室性心动过速及室性期前收缩发生率比较,差异无统计学意义(P>0.05);Dex组患者术后室上性心动过速发生率低于C组(P<0.05)。两组患者术后1年无一例患者死亡。术后3年,C组失访3例,Dex组失访6例。两组患者术后3年病死率比较,差异无统计学意义(P>0.05)。Dex组患者死亡原因为心肌梗死者所占比例低于C组(P<0.05)。结论右美托咪定对行OPCABG的冠心病患者术后1年和3年病死率无明显影响,但可降低患者术后室上性心动过速及心肌梗死发生率。Objective To investigate the impact of dexmedetomidine on long-term prognosis in coronary heart disease patients underwent off-pump coronary artery bypass grafting(OPCABG).Methods A total of 162 coronary heart disease patients underwent OPCABG were selected in the Second Hospital of Hebei Medical University from January 2010 to January 2012,and they were randomly divided into C group and Dex group,each of 81 cases.Patients in C group received intravenous drip of 0.9%sodium chloride injection from the end of the first graft vessel anastomosis to the end of the surgery,then transferred to CICU and received propofolum for 12 hours;patients in Dex group received intravenous drip of dexmedetomidine from the end of the first graft vessel anastomosis to the end of the surgery,then transferred to CICU and received dexmedetomidine for 12 hours.SBP and heart rate 5 minutes after puncture(T0),immediately after surgery(T1),12 hours after surgery(T2),24 hours after surgery(T3),48 hours after surgery(T4)and 72 hours after surgery(T5),incidence of postoperative arrhythmia,1-year and 3-year death status were compared between the two groups.Results There was interaction between time and method in SBP(P<0.05);main effects of time and method were significant in SBP(P<0.05).No interaction was found between time and method in heart rate(P>0.05);main effect of time was not significant in heart rate(P>0.05);main effect of method was significant in heart rate(P<0.05).SBP and heart rate in Dex group were statistically significantly lower than those in C group from T1 to T2(P<0.05).No statistically significant differences of incidence of postoperative atrial fibrillation,ventricular tachycardia or ventricular premature contraction was found between the two groups(P>0.05),while incidence of postoperative supraventricular tachycardia in Dex group was statistically significantly lower than that in C group(P<0.05).No one died in the two groups during the 1-year followup.During the 3-year follow-up,3 cases in C group and 6 cases in Dex group l

关 键 词：冠心病 冠状动脉旁路移植术 非体外循环 右美托咪定 预后 

分 类 号：R541.4[医药卫生—心血管疾病]