中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2011年
5期
550-552
,共3页
寇党培%王准%边卫%韩建阁
寇黨培%王準%邊衛%韓建閣
구당배%왕준%변위%한건각
右美托咪啶%冠状动脉旁路移植术,非体外循环%心肌
右美託咪啶%冠狀動脈徬路移植術,非體外循環%心肌
우미탁미정%관상동맥방로이식술,비체외순배%심기
Dexmedetomidine%Coronary artery bypass,off-pump%Myocardium
目的 评价右美托咪啶对非体外循环冠状动脉旁路移植术患者心肌损伤的影响.方法 择期非体外循环冠状动脉旁路移植术患者46例,性别不限,ASA分级Ⅱ或Ⅲ级,年龄37～64岁,采用随机数字表法,将其随机分为2组(n=23),两组麻醉诱导及麻醉维持方法相同.右美托眯啶组(D组)于麻醉诱导后持续静脉输注右美托咪啶0.5 μg·kg-1∶h-1至术毕,对照组(C组)给予等容量生理盐水.分别于手术开始、血管吻合完毕、血管吻合完毕后30 min和术毕时记录平均肺动脉压、肺毛细血管楔压;中心静脉压和心输出量,计算每搏指数、左室每搏功指数、右室每搏功指数、周围血管阻力和肺血管阻力.分别于麻醉诱导前、术毕、术后4 h和术后24 h时采集静脉血样,采用ELISA法测定血浆心肌肌钙蛋白Ⅰ浓度.结果 与C组比较,D组术毕时每搏指数和左室每搏功指数升高,血管吻合完毕后30 min和术毕时周围血管阻力降低,术后24 h时血浆cTnI浓度降低(P＜0.05);其余血液动力学指标组间差异无统计学意义(P＞0.05).结论 术中静脉输注右美托咪啶0.5 μg·kg-1·h-1可减轻非体外循环冠状动脉旁路移植术患者心肌损伤.
目的 評價右美託咪啶對非體外循環冠狀動脈徬路移植術患者心肌損傷的影響.方法 擇期非體外循環冠狀動脈徬路移植術患者46例,性彆不限,ASA分級Ⅱ或Ⅲ級,年齡37～64歲,採用隨機數字錶法,將其隨機分為2組(n=23),兩組痳醉誘導及痳醉維持方法相同.右美託瞇啶組(D組)于痳醉誘導後持續靜脈輸註右美託咪啶0.5 μg·kg-1∶h-1至術畢,對照組(C組)給予等容量生理鹽水.分彆于手術開始、血管吻閤完畢、血管吻閤完畢後30 min和術畢時記錄平均肺動脈壓、肺毛細血管楔壓;中心靜脈壓和心輸齣量,計算每搏指數、左室每搏功指數、右室每搏功指數、週圍血管阻力和肺血管阻力.分彆于痳醉誘導前、術畢、術後4 h和術後24 h時採集靜脈血樣,採用ELISA法測定血漿心肌肌鈣蛋白Ⅰ濃度.結果 與C組比較,D組術畢時每搏指數和左室每搏功指數升高,血管吻閤完畢後30 min和術畢時週圍血管阻力降低,術後24 h時血漿cTnI濃度降低(P＜0.05);其餘血液動力學指標組間差異無統計學意義(P＞0.05).結論 術中靜脈輸註右美託咪啶0.5 μg·kg-1·h-1可減輕非體外循環冠狀動脈徬路移植術患者心肌損傷.
목적 평개우미탁미정대비체외순배관상동맥방로이식술환자심기손상적영향.방법 택기비체외순배관상동맥방로이식술환자46례,성별불한,ASA분급Ⅱ혹Ⅲ급,년령37～64세,채용수궤수자표법,장기수궤분위2조(n=23),량조마취유도급마취유지방법상동.우미탁미정조(D조)우마취유도후지속정맥수주우미탁미정0.5 μg·kg-1∶h-1지술필,대조조(C조)급여등용량생리염수.분별우수술개시、혈관문합완필、혈관문합완필후30 min화술필시기록평균폐동맥압、폐모세혈관설압;중심정맥압화심수출량,계산매박지수、좌실매박공지수、우실매박공지수、주위혈관조력화폐혈관조력.분별우마취유도전、술필、술후4 h화술후24 h시채집정맥혈양,채용ELISA법측정혈장심기기개단백Ⅰ농도.결과 여C조비교,D조술필시매박지수화좌실매박공지수승고,혈관문합완필후30 min화술필시주위혈관조력강저,술후24 h시혈장cTnI농도강저(P＜0.05);기여혈액동역학지표조간차이무통계학의의(P＞0.05).결론 술중정맥수주우미탁미정0.5 μg·kg-1·h-1가감경비체외순배관상동맥방로이식술환자심기손상.
Objective To evaluate the cardioprotective effect of dexmedetomidine in patients undergoing off-pump coronary artery bypass grafting. Methods Forty-six ASA Ⅱ or Ⅲ patients aged 37-64 yr weighing 54-81 kg undergoing off-pump coronary artery bypass grafting were randomized into 2 groups ( n = 23 each): control group (group C) and dexmedetomidine group (group D) . Dexmedetomidine was infused at 0.5 μg·kg-1·h-1 starting after induction of anesthesia until the end of operation in group D. Radial artery was cannulated and Swan-Ganz catheter placed via right internal jugular vein. HR, MAP, mean pulmonary arterial pressure, pulmonary capilary wedge pressure, central venous pressure, and cardiac output were recorded and stroke volume index, left and right ventricular stroke work index, systemic vascular resistance and pulmonary vascular resistance were calculated at the beginning of operation (T1 ), immediately (T2 ) and at 30 min after reestablishment of coronary blood flow (T3 ) and the end of operation (T4 ) . Venous blood samples were taken before induction of anesthesia (T0 , baseline) , at T4 and 4 h (T5 ) and 24 h (T6 ) after operation for determination of plasma concentration of cardiac troponin I by ELISA. Results Stroke volume index and left ventricular stroke work index were significantly higher at T4 while systemic vascular resistance was lower at T34 in group D than in group C. Plasma cardiac troponin Ⅰ concentration was significantly lower at T6 in group D than in group C. Conclusion Dexmedetomidine infusion at 0.5 μg ·kg-1·h-1 during operation can protect myocardium in patients undergoing off-pump coronary artery bypass grafting.
