七氟醚联合右美托咪定对不停跳冠状动脉搭桥患者脑氧代谢及心率变异性的影响分析  

Effect of sevoflurane plus dexmedetomidine on cerebral oxygen metabolism and heart rate variability of patients during beating coronary artery bypass grafting

作　　者：涂仁书 王硕 巢齐放[1] 蒋平[1] Tu Renshu;Wang Shuo;Chao Qifang;Jiang Ping(Department of Anesthesiology,Changzhou Wujin People′s Hospital,Jiangsu 213002,China)

机构地区：[1]江苏省常州市武进人民医院麻醉科,213002

出　　处：《中国药物与临床》2021年第15期2645-2647,共3页Chinese Remedies & Clinics

摘　　要：目的探究七氟醚联合右美托咪定对不停跳冠状动脉搭桥患者脑氧代谢及心率变异性的影响。方法选取2016年11月至2019年11月于我院接受心脏不停跳冠状动脉搭桥手术患者68例,经过简单随机抽样双盲法将研究对象分为研究组(34例)和对照组(34例)。比较2组患者不同时间点的脑氧代谢及心率变异性。结果与术前相比,研究组脑氧摄取率(CERO_(2))和动脉-颈内静脉血氧含量差(AVDO_(2))在麻醉诱导后30 min、术后12 h的水平呈显著下降趋势,且明显低于对照组(P<0.05);研究组颈静脉部血氧饱和度(SjvO_(2))水平在麻醉诱导时下降,术后逐渐恢复,差异具有统计学意义(P<0.05)。与麻醉前相比,研究组心率变异性在麻醉诱导后5 min、10 min、15 min的低频(LF)、LF/高频(HF)呈显著下降趋势,且组间差异具有统计学意义(P<0.05);而HF无明显变化。与麻醉前相比,对照组在麻醉诱导后5 min、10 min、15 min的HF明显下降(P<0.05),LF/HF明显升高(P<0.05),而LF先降后升,差异具有统计学意义(P<0.05)。结论在不停跳冠状动脉搭桥患者手术围术期使用使用七氟醚联合右美托咪定作为麻醉诱导,可减少心率变异性,发挥心肌保护作用,同时可维持脑氧代谢平衡作用,对患者预后具有重要临床意义。Objective To investigate the effect of sevoflurane plus dexmedetomidine on cerebral oxygen metabolism and heart rate variability(HRV)of patients during beating coronary artery bypass grafting.Methods A total of 68 patients who underwent beating heart coronary artery bypass surgery in our hospital between November 2016 and November 2019 were included.Using simple random sampling and double-blind approach,the subjects were divided into a study group(n=34)and a control group(n=34).The two groups were compared for cerebral oxygen metabolism and heart rate variability at different time points.Results Compared with before operation,the levels of cerebral metabolic rate of oxygen(CMRO_(2))and the arteriovenous oxygen difference(AVDO_(2))in the study group showed a significant downward trend from 30 minutes after induction of anesthesia through 12 hours after operation,and were significantly lower than those in the control group(P<0.05).The level of jugular vein oxygen saturation(SjvO_(2))in the study group fell during induction of anesthesia and gradually returned after operation,with statistically significant differences(P<0.05).Compared with before anesthesia,the study group showed significant decline in low-frequency(LF)and LF/high-frequency(HF)HRV ratio(LF/HF)at 5,10,and 15 minutes after induction of anesthesia(P<0.05),but not in high-frequency(HF)HRV.Compared with before anesthesia,the control group showed significant decline in HF and a significant increase in LF/HF at 5,10,and 15 minutes after induction of anesthesia(P<0.05),while the LF first decreased and then increased,with significant differences(P<0.05).Conclusion Perioperative use of sevoflurane plus dexmedetomidine for anesthesia induction in beating coronary artery bypass grafting can reduce HRV,protect the myocardium,and maintain the balance in cerebral oxygen metabolism.This can be clinical relevant for prognosis of patients.

关 键 词：右美托咪定 七氟醚 不停跳冠脉搭桥 脑氧代谢 心率变异性 

分 类 号：R614[医药卫生—麻醉学]