摘要
目的观察右美托咪定(dexmedetomidine,Dex)在快通道麻醉下非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)中的作用和可行性。方法选择OPCABG患者80例,根据随机数字表法分为对照组(C组)和右美托咪定组(D组),每组40例。D组于麻醉诱导前15 min给予Dex 0.6μg/kg,然后以0.5μg·kg^-1·h^-1泵注至合拢胸骨;C组麻醉诱导前15 min给予等容量0.9%氯化钠溶液。分别测定两组患者麻醉诱导前15 min(T0)、注射Dex或0.9%氯化钠溶液后5 min(T1)、气管插管完成即刻(T2)、手术开始(T3)、锯胸骨(T4)、第一支桥血管吻合前(T5)、最后一支桥血管吻合完毕(T6)、合拢胸骨(T7)时的心率、MAP,记录两组患者术中去氧肾上腺素、硝酸甘油、阿托品的使用量,记录两组患者术后拔管时间、ICU停留时间,VAS评价术后8 h、24 h痛觉评分,记录两组患者术后24 h内低血压、心动过缓、恶心呕吐等不良反应发生情况。结果T0时点两组患者心率、MAP比较差异无统计学意义(P>0.05)。与T0时点比较:D组患者T1~T7的心率明显减低,两组患者T5~T7时点MAP均明显降低,差异有统计学意义(P<0.05)。与C组比较,D组患者T1~T7时点的心率均明显降低,差异有统计学意义(P<0.05);两组各时点MAP差异无统计学意义(P>0.05)。两组患者术中使用去甲肾上腺素、硝酸甘油差异无统计学意义(P>0.05),D组阿托品用量明显增加(P<0.05)。两组患者术后拔管时间、ICU停留时间、手术后24 h VAS评分差异无统计学意义(P>0.05);D组术后8 h VAS评分明显低于C组,差异有统计学意义(P<0.05)。结论对于快通道麻醉下行OPCABG患者,Dex有利于术中血流动力学稳定并提供良好术后镇痛。
Objective To observe the effects and feasibility of dexmedetomidine(Dex)on off-pump coronary artery bypass grafting(OPCABG)under fast track anesthesia.Methods Eighty patients undergoing OPCABG were selected.According to the random number table method,they were divided into two group(n=40):a control group(group C)and a dexmedetomidine group(group D).Patients in group D were treated with 0.6μg/kg Dex 15 min before anesthesia induction,followed by pump infusion at a rate of 0.5μg·kg^-1·h^-1 until closure of the sternum.In group C,an equal volume of 0.9%sodium chloride was given 15 min before anesthesia induction.The heart rate and mean arterial pressure(MAP)were measured 15 min before anesthesia induction(T0),5 min after injection of Dex or 0.9%sodium chloride(T1),immediately after tracheal intubation(T2),at the beginning of operation(T3),the time of division the sternum(T4),before anastomosis of the first vessel(T5),after anastomosis of the last vessel(T6),and when the sternum was closed(T7).The dosage of norepinephrine,nitroglycerin and atropine in the two groups were recorded.The extubation time and the length of ICU stay were recorded.The Visual Analogy Scale(VAS)score was used to evaluate the pain 8 h and 24 h after operation.The incidence of hypotension,bradycardia,nausea and vomiting were recorded within 24 h after operation.Results There was no significant difference in heart rate and MAP between the two groups at T0(P>0.05).Compared with those at T0,patients in group D presented remarkably decreased heart rate from T1 to T7,while both groups presented significantly reduced MAP from T5 to T7(P<0.05).Compared with group C,patients in group D presented remarkably decreased heart rate from T1 to T7(P<0.05).However,no statistical difference was found as to MAP between the two groups at each time point(P>0.05).There was no significant difference in the dosage of norepinephrine and nitroglycerin between the two groups(P>0.05).Compared with group C,the dosage of atropine in group D significantly increased(P<0.05).There was no significant difference in extubation time,the length of ICU stay and VAS score 24 h after operation between the two groups(P>0.05).The VAS score 8 h after operation in group D was significantly lower than that in group C(P<0.05).Conclusions Dex can stabilize hemodynamics and provide good postoperative analgesia for OPCABG under fast track anesthesia.
作者
杨一辰
孙义伟
刘成彪
徐艳冰
Yang Yichen;Sun Yiwei;Liu Chengbiao;Xu Yanbing(Department of Anesthesiology,Zoucheng People's Hospital,Zoucheng 273500,China;Department of Anesthesiology,Yan Kuang New Journey General Hospital,Zoucheng 273500,China;Department of Anesthesiology,Shandong Provincial Hospital,Jinan 250021,China)
出处
《国际麻醉学与复苏杂志》
CAS
2020年第10期961-965,共5页
International Journal of Anesthesiology and Resuscitation
基金
吴阶平医学基金会临床科研专项资助基金(320.6750.18195)。
