摘要
目的探讨右美托咪定在非体外循环冠状动脉旁路移植术（off-pump coronary artery bypass grafting,OPCABG）中的应用价值,尤其是对心肌的影响。方法选择择期行OPCABG患者96例,按随机数字表法分为对照组（C组）和右美托咪定组（D组）各48例。两组麻醉诱导用药和方式相同,D组辅助应用右美托咪定,C组静脉泵注等量生理盐水。比较两组手术时间、出血量以及麻醉开始前（T0）、插管后2 min（T1）、手术切皮后（T2）、劈胸骨后（T3）、阻断冠状动脉开始搭桥时（T4）、冠状动脉旁路移植结束即刻（T5）、冠状动脉旁路移植后8 h（T6）、24 h（T7）的血流动力学指标和T0、T6、T7及冠状动脉旁路移植结束后96 h（T8）血清心肌肌钙蛋白I（cTnI）、磷酸肌酸激酶同工酶（CK-MB）的变化,记录术中用药量及术后恢复情况。结果两组T2、T3时间点MAP均较T0升高,且D组低于C组（P〈0.05）;D组T1～T3时HR低于C组（P〈0.05）;D组T6～T7时间点CK-MB和cTnI浓度明显低于C组（P〈0.05）;D组血管活性药物用量及术后恢复时间均小于C组（P〈0.05）;两组患者ICU住院时间、并发症和死亡率差异无统计学意义（P〉0.05）。结论 OPCABG患者全程静脉使用右美托咪定,对心肌有一定的保护作用。
Objective To observe the application values,especially the effect of myocardial preservation,of dexmedetomidine in off-pump coronary artery bypass grafting（OPCABG）.Methods Ninety-six patients were randomly divided into control group（group C） and dexmedetomidine group（group D）,48 in each group.The medications and methods of anesthesia induction in the two groups were identical.The group D was administrated with dexmedetomidine while the group C was applied with the same volume of saline.The operative time and intraoperative blood loss were compared between the two groups.Furthermore,hemodynamics before start of anesthesia（T0）,after 2 min of intubation tube（T1）,after skin incision（T2）,after sternotomy（T3）,at the beginning of bypass surgery for interrupted coronary artery（T4）,at the end of coronary bypass grafting（T5）,after 8 h（T6） and 24 h（T7） of the operation were observed.Meanwhile,changes of serum cardiac troponin I（cTnI） and creatine kinase isoenzyme（CK-MB） at T0,T6,T7 and 96 h（T8） after the operation were also observed.The amount of drugs used and postoperative recovery were recorded.Results The mean artery pressure（MAP） was significantly higher at T2 and T3when compared to T0 in the both groups.The MAP was higher in the group C than that in the group D（P〈0.05）.The heart rate at T1,T2 and T3in the group D was significantly lower than that in the group C（P〈0.05）.Serum levels of CK-MB and cTnI at T6,T7 and T8 in the group D was significantly lower than that in the group C（P〈0.05）.There were less medication and faster postoperative recovery in the group D when compared to that in the group C.No significant differences in hospitalization time in ICU,complications and mortality were found between the two groups.Conclusion Dexmedetomidine administration for patients during OPCABG has a myocardial protective effect.
出处
《实用医院临床杂志》
2015年第4期86-89,共4页
Practical Journal of Clinical Medicine
