CAJ | 학술논문

目的评价右美托咪啶复合小剂量舒芬太尼对非体外循环冠状动脉旁路移植术患者麻醉诱导期间血液动力学的影响.方法拟行非体外循环冠状动脉旁路移植术患者75例,性别不限,年龄46～ 72岁,体重59～86 kg,ASA分级Ⅱ级或Ⅲ级,NYHA心功能分级Ⅱ级或Ⅲ级,左室射血分数≥45％.采用随机数字表法,将患者随机分为3组(n=25):右美托咪啶复合小剂量舒芬太尼组(DS组)、小剂量舒芬太尼组(S1组)和大剂量舒芬太尼组(S2组).DS组以60ml/h的速率静脉输注右美托咪啶0.8 μg/kg(溶于15 ml生理盐水中)15 min;S1组和S2组给予等容量生理盐水.麻醉诱导:静脉注射咪达唑仑0.08mg/kg和哌库溴铵0.12 mg/kg;在静脉注射总量1/3的咪达唑仑和总量1/8的哌库溴铵后,DS组、S1组和S2组分别静脉注射舒芬太尼0.5、0.5和0.8 μg/kg(用生理盐水稀释至10 ml),再静脉注射余量的咪达唑仑；当BIS值≤75时,静脉注射余量哌库溴铵；当BIS值≤55时行气管插管,机械通气,维持PETCO2 30～ 35 mm Hg.记录麻醉诱导期间心血管不良事件的发生情况以及药物干预的情况.结果与S2组比较,S1组高血压和心动过速的发生率升高,S1组和DS组低血压发生率降低,DS组药物干预率降低(P＜0.05)；与S1组比较,DS组高血压、低血压和心动过度的发生率降低,心动过缓发生率升高,药物干预率降低(P＜0.05).结论右美托咪啶(0.8 μg/kg)复合较小剂量舒芬太尼(0.5μg/kg)有利于稳定非体外循环冠状动脉旁路移植术患者麻醉诱导期间的血液动力学.
목적 평개우미탁미정복합소제량서분태니대비체외순배관상동맥방로이식술환자마취유도기간혈액동역학적영향.방법 의행비체외순배관상동맥방로이식술환자75례,성별불한,년령46～ 72세,체중59～86 kg,ASA분급Ⅱ급혹Ⅲ급,NYHA심공능분급Ⅱ급혹Ⅲ급,좌실사혈분수≥45％.채용수궤수자표법,장환자수궤분위3조(n=25):우미탁미정복합소제량서분태니조(DS조)、소제량서분태니조(S1조)화대제량서분태니조(S2조).DS조이60ml/h적속솔정맥수주우미탁미정0.8 μg/kg(용우15 ml생리염수중)15 min;S1조화S2조급여등용량생리염수.마취유도:정맥주사미체서륜0.08mg/kg화고고추안0.12 mg/kg;재정맥주사총량1/3적미체서륜화총량1/8적고고추안후,DS조、S1조화S2조분별정맥주사서분태니0.5、0.5화0.8 μg/kg(용생리염수희석지10 ml),재정맥주사여량적미체서륜；당BIS치≤75시,정맥주사여량고고추안；당BIS치≤55시행기관삽관,궤계통기,유지PETCO2 30～ 35 mm Hg.기록마취유도기간심혈관불량사건적발생정황이급약물간예적정황.결과 여S2조비교,S1조고혈압화심동과속적발생솔승고,S1조화DS조저혈압발생솔강저,DS조약물간예솔강저(P＜0.05)；여S1조비교,DS조고혈압、저혈압화심동과도적발생솔강저,심동과완발생솔승고,약물간예솔강저(P＜0.05).결론 우미탁미정(0.8 μg/kg)복합교소제량서분태니(0.5μg/kg)유리우은정비체외순배관상동맥방로이식술환자마취유도기간적혈액동역학.
Objective To investgate the effects of dexmedetomidine combined with small-dose of sufentanil on the hemodynamics during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting.Methods Seventy-five ASA Ⅱ or Ⅲ and NYHA Ⅱ or Ⅲ patients aged 46-72 yr,weighing 59-86 kg,ejection fraction ≥45％,undergoing off-pump coronary artery bypass grafting,were randomly divided into 3 groups ( n =25):dexmedetomidine combined with small-dose of sufentanil group (group DS),small-dose of sufentanil group (group S1 ) and large-dose of sufentanil group (group S2 ).In group DS,dexmedetomidine 0.8 μg/kg (diluted with normal saline to 15 ml) was injected for 15 min at a rate of60 ml/h,while the same volume of normal saline were given in groups S1 and S2.Anesthesia was induced with midasolam 0.08 mg/kg and pipecuronium 0.12 mg/kg.After administration of the total dose of 1/3 midazolam and 1/8 pipecuronium,sufentanil 0.5,0.5 and 0.8μg/kg (diluted with narmalsaline to 10 ml) were injected in groups DS,S1 and S2 respectively.Then the rest of midazolam was injected.When BIS value ≤ 75,the rest of pipecuronium was injected.When BIS value ≤ 55,the patients were tracheal intubated and mechanically ventilated.PETCO2 was maintained at 30-35 mm Hg.The adverse ardiovascular events (hypertension,hypotension,tachycardia and bradycardia) and drugs intervention were recorded during anesthesia induction.Results Compared with group S2,the incidence of hypertension and tachycardia was significantly increased in group S1,the incidence of hypotension decreased in groups S1 and DS,the incidence of drug intervention decreased in group DS (P ＜ 0.05).Compared with group S1,the incidence of hypertension,hypotension and tachycardia was significantly decreased,the incidence of bradycardia increased,theincidence of drug intervention decreased in group DS (P ＜ 0.05).Conclusion Dexmedetomidine (0.8 μg/kg) combined with small-dose of sufentanil (0.5 μg/kg) is beneficial for keep the stable of hemodynamics during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting.