不同剂量右美托咪定对成人体外循环心脏手术后血流动力学的影响研究  

Effects of Different Doses of Dexmedetomidine on Hemodynamics After Adult Cardiopulmonary Bypass Cardiac Surgery

作　　者：许治华 陈硕 兰蕴平[2] 罗继文 XU Zhihua;CHEN Shuo;LAN Yunping;LUO Jiwen(Dept.of Critical Care Medicine,Mianyang Central Hospital,Mianyang Hospital,School of Medicine,University of Electronic Science and Technology of China,Sichuan Mianyang 621000,China;Dept.of Critical Care Medicine,Sichuan Provincial People’s Hospital,Chengdu 610000,China)

机构地区：[1]电子科技大学医学院附属绵阳医院/绵阳市中心医院重症医学科,四川绵阳621000 [2]四川省人民医院重症医学科,成都610000

出　　处：《中国医院用药评价与分析》2023年第5期543-546,551,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：四川省卫生和计划生育科研课题(No.18PJ438);四川省医学会课题项目(No.2015ZZ010)。

摘　　要：目的:探讨不同剂量右美托咪定对成人体外循环心脏手术后血流动力学的影响。方法:将2019年1月至2021年9月绵阳市中心医院收治的体外循环心脏手术后的成年患者共180例采用随机数字表法分为对照组、低剂量组和高剂量组(每组60例)。低剂量组患者给予右美托咪定0.4μg/(kg·h)泵入,高剂量组患者给予右美托咪定0.8μg/(kg·h)泵入,对照组患者给予等量0.9%氯化钠注射液泵入,其余处理方案三组一致。测量进入重症监护室(ICU)时(T_(0)),进入ICU后6 h(T_(1))、12 h(T_(2))和24 h(T_(3))的血流动力学指标和心肌酶学指标水平,记录心律失常发生率及最终点ICU停留时间。结果:低剂量组和高剂量组患者在T_(1)、T_(2)、T_(3)时的心输出量大于对照组,静脉血肌钙蛋白I、肌酸激酶同工酶及乳酸水平低于对照组,但未表现出明显剂量-效应关系。高剂量组患者较低剂量组和对照组更易出现缓慢型心律失常,但使用右美托咪定能缩短ICU停留时间。结论:使用右美托咪定可以稳定体外循环心脏手术后血流动力学,并对心肌缺血再灌注损伤起到一定的保护作用,缩短ICU停留时间,但无明显剂量-效应关系。使用高剂量的右美托咪定更易出现低血压及缓慢型心律失常。OBJECTIVE:To probe into the effects of different doses of dexmedetomidine on hemodynamics after adult cardiopulmonary bypass cardiac surgery.METHODS:A total of 180 patients with cardiopulmonary bypass in Mianyang Central Hospital from Jan.2019 to Sept.2021 were divided into the control group,low-dose group and high-dose group by random number table method(with 60 cases in each group).The low-dose group was given dexmedetomidine 0.4μg/(kg·h)pumped,the high-dose group received dexmedetomidine 0.8μg/(kg·h)pumped,the control group received an equal amount of 0.9%sodium chloride injection pumped,and the rest of the treatment protocol was consistent among the three groups.Hemodynamic parameters and myocardial enzymatic levels were measured at the time of admission to the ICU(T_(0)),after admission to the ICU of 6 h(T_(1)),12 h(T_(2))and 24 h(T_(3)).The incidence of arrhythmia and final length of stay in ICU were recorded.RESULTS:Patients in the low-dose group and high-dose group had greater cardiac output at T_(1),T_(2),and T_(3)than the control group,and lower venous blood troponin I,creatine kinase isoenzyme,and lactate levels than the control group,yet did not show a significant dose-effect relationship.Patients in the high-dose group were more likely to develop bradyarrhythmia than those in the low-dose group and the control group,yet the use of dexmedetomidine could shorten the length of stay in ICU.CONCLUSIONS:Dexmedetomidine can stabilize hemodynamics after cardiac surgery with cardiopulmonary bypass,protect against myocardial ischemia-reperfusion injury,and shorten the length of stay in ICU,yet there is no significant dose-effect relationship.The use of high-dose dexmedetomidine is more likely to result in hypotension and bradycardia.

关 键 词：右美托咪定 体外循环心脏手术 血流动力学 心肌缺血再灌注损伤 随机对照试验 

分 类 号：R971.2[医药卫生—药品]