右美托咪定联合舒芬太尼对体外循环下心脏瓣膜置换术患者血流动力学的影响及心肺功能的保护作用研究  

Effect of Dextrometramidine Combined with Sufentanil on Hemodynamics in Patients Undergoing Heart Valve Replacement under Cardiopulmonary Bypass and Its Protective Effect for Cardiorespiratory Function

作　　者：隆雨秋 张莉[1] 陈均[2] 赵永军[1] 曾恒 王义[1] LONG Yuqiu;ZHANG Li;CHEN Jun;ZHAO Yongjun;ZENG Heng;WANG Yi(Department of Anesthesiology,the First People's Hospital of Guangyuan,Guangyuan 628000,China;Department of Cardiothoracic Surgery,the First People's Hospital of Guangyuan,Guangyuan 628000,China)

机构地区：[1]四川省广元市第一人民医院麻醉科,628000 [2]四川省广元市第一人民医院心胸外科,628000

出　　处：《实用心脑肺血管病杂志》2021年第7期80-85,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：广元市重点研发项目(19ZDYF0064)。

摘　　要：背景心脏瓣膜置换术是否成功与术中心肌保护措施密切相关,而术中心肌损伤主要与手术导致机体出现强烈应激反应、血流动力学不稳定、心脏供氧失衡等有关。因此,术中保护心肌、抑制应激反应对心脏瓣膜置换术效果具有重要意义。目的探讨右美托咪定联合舒芬太尼对体外循环(CPB)下心脏瓣膜置换术患者血流动力学的影响及心肺功能的保护作用。方法选取2018年1月—2020年1月广元市第一人民医院收治的116例行择期CPB下心脏瓣膜置换术的患者作为研究对象,采用随机数字表法分为对照组和观察组,每组58例。两组均采用静吸复合麻醉,观察组患者麻醉诱导前及术中、术后采用右美托咪定联合舒芬太尼镇痛,对照组患者仅采用舒芬太尼镇痛。比较两组患者镇痛效果(包括术后异丙酚用量、静脉自控镇痛药液用量、吗啡使用率),术前、插管后、切皮时、劈胸骨时、CPB前、CPB停机10 min后血流动力学指标[包括心率(HR)和平均动脉压(MAP)],CPB前、CPB停机12 h后心肌损伤指标[包括心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)]和肺功能指标[包括动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))和氧合指数(OI)];并记录两组患者麻醉相关不良反应发生情况。结果两组均无延迟气管导管拔出者。观察组患者术后异丙酚用量少于对照组,吗啡使用率低于对照组(P<0.05)。时间与方法在HR、MAP上存在交互作用(P<0.05);时间、方法在HR、MAP上主效应均显著(P<0.05)。观察组患者插管后和劈胸骨时HR慢于对照组,切皮时和CPB前HR快于对照组(P<0.05);观察组患者插管后和劈胸骨时MAP低于对照组,切皮时和CPB停机10 min后MAP高于对照组(P<0.05)。观察组患者CPB停机12 h后cTnI、CK-MB水平低于对照组(P<0.05)。观察组患者CPB停机12 h后PaO_(2)和OI高于对照组,PaCO_(2)低于对照组(P<0.05);两组患者CPB停机12 h后PaO_(2)、Background It is closely related to the protective measures of myocardium that whether the heart valve replacement is successful,and the main causes of myocardial damage intraoperative are the strong stress reaction caused by operation,hemodynamic instability and imbalance of cardiac oxygen supply.Therefore,it is of great significance to protect myocardium and inhibit stress response during operation for heart valve replacement.Objective To investigate the effect of dextrometramidine combined with sufentanil on hemodynamics in patients undergoing heart valve replacement under cardiopulmonary bypass(CPB)and its protective effect for cardiorespiratory function.Methods From January 2018 to January 2020,116 patients undergoing elective cardiac valve replacement under CPB in the First People’s Hospital of Guangyuan were selected as the research objects,and they were randomly divided into control group and observation group using random number table method,58 cases in each group.Both groups of patients were given combined intravenous and inhalation anesthesia.The observation group was given dexmedetomidine combined with sufentanil for analgesia before anesthesia induction,during and after operation,while the control group was only given sufentanil for analgesia.The analgesic effects(including dosage of propofol after operation,dosage of patient-controlled intravenous analgesia liquid medicine,morphine usage rate),hemodynamic parameters[including heart rate(HR)and average arterial pressure(MAP)]at different time points(including before operation,after intubation,during skin incision,during sternotomy,before CPB and 10 minutes after CPB shutdown),myocardial injury markers[including cardiac troponin I(cTnI)and creatine kinase isoenzyme(CK-MB)]and pulmonary function indexes[including arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and oxygenation index(OI)]before CPB and 12 hours after CPB shutdown were compared between the two groups.And anesthesia related adverse reacti

关 键 词：心脏瓣膜置换术 体外循环 右美托咪定 舒芬太尼 血流动力学 心肺功能 

分 类 号：R614.2[医药卫生—麻醉学]