目的 探讨右美托咪定(dexmedetomidine,Dex)持续输注对非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)患者血流动力学及应激反应的影响. 方法 择期行OPCABG患者60例,年龄45岁～65岁,体重55 kg～85 kg,美国麻醉医师协会(ASA)分级Ⅱ或Ⅲ级,采用随机数字表法分为Dex组(D组)和对照组(C组),每组30例.D组于麻醉诱导前静脉泵注负荷剂量的Dex 0.5 μg/kg,10 min泵注完成后随即在麻醉诱导的同时以0.5μg·kg-1·h-1的速率泵注至术毕;C组以同样的方式泵注等量生理盐水.分别于泵注药物前(T0)、泵注完负荷量药物即刻(T1)、气管插管时(T2)、锯胸骨时(T3)、吻合前降支时(T4)、吻合右冠状动脉或后降支时(T5)、吻合回旋支或对角支时(T6)、吻合近端时(T7)、吻合血管完毕后10 min(T8)、手术结束时(T9)、拔出气管导管时(T10)记录各项血流动力学参数,并记录术中窦性心动过缓、窦性心动过速、低血压和高血压的发生次数以评价循环稳定性.分别于T0、T3、T8、T9、T10时检测血糖(glucose,Glu)、皮质醇(cortisol,Cot)、去甲肾上腺素(noradrenaline,NE)、肾上腺素(epinephrine,E)浓度,并记录术中芬太尼用量. 结果 与T0时比较,C组T2～T8、T10时心率(heart rate,HR)明显增快(P＜0.05);T2、T3、T10时平均动脉压(mean arterial pressure,MAP)明显升高,而T4～T7时MAP明显降低(P＜0.05);T3～T8时平均肺动脉压(mean pulmonary artery pressure,MPAP)、肺循环阻力指数(pulmonary vascular resistance index,PVRI)、体循环阻力指数(system vascular resistance index,SVRI)明显升高(P＜0.05).与C组比较,D组T1 ～T10时HR明显减慢(P＜0.05),T1～T3、T9、T10时MAP明显降低(P＜0.05);而T～T7时两组MAP差异无统计学意义(P＞0.05);T1～T10时PVRI、SVRI明显降低(P＜0.05);T7～T8时心脏指数(cardiac index,CI)、左心每搏作功指数(left ventricular stroke work index,LVSWI)、右心每搏作功指数(right ventricular stroke work index,RVSWI)明显增高(P＜0.05);术中窦性心动过速、高血压发生率明显降低(P＜0.05),但两组窦性心动过缓和低血压的发生率差异无统计学意义(P＞0.05).与T0时比较,两组T3、T8～T10时Glu、Cor、NE及E浓度显著增加(P＜0.05);但与C组比较,D组T3、T8～T10时Glu[(6.7±0.8)、(6.9±0.8)、(6.8±0.8)、(6.4±0.7) mmol/L]、Cor[(744±28)、(834±46)、(782±47)、(733±40) μmol/L]、NE[(3 325±160)、(3 866±221)、(3 307±184)、(3 153±81) nmol/L]及E[(552±38)、(652±41)、(603±39)、(558±43) nmol/L]浓度显著降低(P＜0.05);D组围术期芬太尼用量明显减少(P＜0.05). 结论 术中持续泵注Dex能稳定OPCABG患者围术期血流动力学和应激激素水平,减轻应激反应,降低术中不良事件发生率.
目的 探討右美託咪定(dexmedetomidine,Dex)持續輸註對非體外循環冠狀動脈徬路移植術(off-pump coronary artery bypass grafting,OPCABG)患者血流動力學及應激反應的影響. 方法 擇期行OPCABG患者60例,年齡45歲～65歲,體重55 kg～85 kg,美國痳醉醫師協會(ASA)分級Ⅱ或Ⅲ級,採用隨機數字錶法分為Dex組(D組)和對照組(C組),每組30例.D組于痳醉誘導前靜脈泵註負荷劑量的Dex 0.5 μg/kg,10 min泵註完成後隨即在痳醉誘導的同時以0.5μg·kg-1·h-1的速率泵註至術畢;C組以同樣的方式泵註等量生理鹽水.分彆于泵註藥物前(T0)、泵註完負荷量藥物即刻(T1)、氣管插管時(T2)、鋸胸骨時(T3)、吻閤前降支時(T4)、吻閤右冠狀動脈或後降支時(T5)、吻閤迴鏇支或對角支時(T6)、吻閤近耑時(T7)、吻閤血管完畢後10 min(T8)、手術結束時(T9)、拔齣氣管導管時(T10)記錄各項血流動力學參數,併記錄術中竇性心動過緩、竇性心動過速、低血壓和高血壓的髮生次數以評價循環穩定性.分彆于T0、T3、T8、T9、T10時檢測血糖(glucose,Glu)、皮質醇(cortisol,Cot)、去甲腎上腺素(noradrenaline,NE)、腎上腺素(epinephrine,E)濃度,併記錄術中芬太尼用量. 結果 與T0時比較,C組T2～T8、T10時心率(heart rate,HR)明顯增快(P＜0.05);T2、T3、T10時平均動脈壓(mean arterial pressure,MAP)明顯升高,而T4～T7時MAP明顯降低(P＜0.05);T3～T8時平均肺動脈壓(mean pulmonary artery pressure,MPAP)、肺循環阻力指數(pulmonary vascular resistance index,PVRI)、體循環阻力指數(system vascular resistance index,SVRI)明顯升高(P＜0.05).與C組比較,D組T1 ～T10時HR明顯減慢(P＜0.05),T1～T3、T9、T10時MAP明顯降低(P＜0.05);而T～T7時兩組MAP差異無統計學意義(P＞0.05);T1～T10時PVRI、SVRI明顯降低(P＜0.05);T7～T8時心髒指數(cardiac index,CI)、左心每搏作功指數(left ventricular stroke work index,LVSWI)、右心每搏作功指數(right ventricular stroke work index,RVSWI)明顯增高(P＜0.05);術中竇性心動過速、高血壓髮生率明顯降低(P＜0.05),但兩組竇性心動過緩和低血壓的髮生率差異無統計學意義(P＞0.05).與T0時比較,兩組T3、T8～T10時Glu、Cor、NE及E濃度顯著增加(P＜0.05);但與C組比較,D組T3、T8～T10時Glu[(6.7±0.8)、(6.9±0.8)、(6.8±0.8)、(6.4±0.7) mmol/L]、Cor[(744±28)、(834±46)、(782±47)、(733±40) μmol/L]、NE[(3 325±160)、(3 866±221)、(3 307±184)、(3 153±81) nmol/L]及E[(552±38)、(652±41)、(603±39)、(558±43) nmol/L]濃度顯著降低(P＜0.05);D組圍術期芬太尼用量明顯減少(P＜0.05). 結論 術中持續泵註Dex能穩定OPCABG患者圍術期血流動力學和應激激素水平,減輕應激反應,降低術中不良事件髮生率.
목적 탐토우미탁미정(dexmedetomidine,Dex)지속수주대비체외순배관상동맥방로이식술(off-pump coronary artery bypass grafting,OPCABG)환자혈류동역학급응격반응적영향. 방법 택기행OPCABG환자60례,년령45세～65세,체중55 kg～85 kg,미국마취의사협회(ASA)분급Ⅱ혹Ⅲ급,채용수궤수자표법분위Dex조(D조)화대조조(C조),매조30례.D조우마취유도전정맥빙주부하제량적Dex 0.5 μg/kg,10 min빙주완성후수즉재마취유도적동시이0.5μg·kg-1·h-1적속솔빙주지술필;C조이동양적방식빙주등량생리염수.분별우빙주약물전(T0)、빙주완부하량약물즉각(T1)、기관삽관시(T2)、거흉골시(T3)、문합전강지시(T4)、문합우관상동맥혹후강지시(T5)、문합회선지혹대각지시(T6)、문합근단시(T7)、문합혈관완필후10 min(T8)、수술결속시(T9)、발출기관도관시(T10)기록각항혈류동역학삼수,병기록술중두성심동과완、두성심동과속、저혈압화고혈압적발생차수이평개순배은정성.분별우T0、T3、T8、T9、T10시검측혈당(glucose,Glu)、피질순(cortisol,Cot)、거갑신상선소(noradrenaline,NE)、신상선소(epinephrine,E)농도,병기록술중분태니용량. 결과 여T0시비교,C조T2～T8、T10시심솔(heart rate,HR)명현증쾌(P＜0.05);T2、T3、T10시평균동맥압(mean arterial pressure,MAP)명현승고,이T4～T7시MAP명현강저(P＜0.05);T3～T8시평균폐동맥압(mean pulmonary artery pressure,MPAP)、폐순배조력지수(pulmonary vascular resistance index,PVRI)、체순배조력지수(system vascular resistance index,SVRI)명현승고(P＜0.05).여C조비교,D조T1 ～T10시HR명현감만(P＜0.05),T1～T3、T9、T10시MAP명현강저(P＜0.05);이T～T7시량조MAP차이무통계학의의(P＞0.05);T1～T10시PVRI、SVRI명현강저(P＜0.05);T7～T8시심장지수(cardiac index,CI)、좌심매박작공지수(left ventricular stroke work index,LVSWI)、우심매박작공지수(right ventricular stroke work index,RVSWI)명현증고(P＜0.05);술중두성심동과속、고혈압발생솔명현강저(P＜0.05),단량조두성심동과완화저혈압적발생솔차이무통계학의의(P＞0.05).여T0시비교,량조T3、T8～T10시Glu、Cor、NE급E농도현저증가(P＜0.05);단여C조비교,D조T3、T8～T10시Glu[(6.7±0.8)、(6.9±0.8)、(6.8±0.8)、(6.4±0.7) mmol/L]、Cor[(744±28)、(834±46)、(782±47)、(733±40) μmol/L]、NE[(3 325±160)、(3 866±221)、(3 307±184)、(3 153±81) nmol/L]급E[(552±38)、(652±41)、(603±39)、(558±43) nmol/L]농도현저강저(P＜0.05);D조위술기분태니용량명현감소(P＜0.05). 결론 술중지속빙주Dex능은정OPCABG환자위술기혈류동역학화응격격소수평,감경응격반응,강저술중불량사건발생솔.
Objective To evaluate the effect of dexmedetomidine on hemodynamic and stress reaction in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods Sixty patients,ASA Ⅱ or Ⅲ,aged 45 y-65 y,weighting 55 kg-86 kg,scheduled for OPCABG,were randomly assigned to two groups:the group dexmedetomidine (group D,n=30) and the group control (group C,n=30).Patients in group D received an initial bolus dose of dexmedetomidine (0.5 μg/kg) over 10 min before anesthesia induction followed by a continuous infusion of 0.5 μg ·kg-1 ·h-1 until the end of the operation.Group C received equal volume of normal saline.Hemodynamic parameters were recorded before injection (T0),after initial bolus dose infusion (T1),when tracheal intubation (T2),sternotomy (T3),at anastomosis of left anterior descending (T4),at anastomosis of right coronary artery or posterior descending artery (T5),at anastomosis of left circumflex cornary artery or diagonal artery (T6),at anastomosis of aortic (T7),at 10 min after reestablishment of coronary blood flow (T8),end of operation (T9) and after tracheal extubation (T10).The stability of circulation was evaluated and consumption of fentany in both groups was recorded.Concentrations of blood glucose,cortisol,norepinephrine and epinephrine were measured at T0,T3,T8-T10.Results There was significant difference between group D and group C in heart rate (HR) at T1-T10,mean arterial pressure (MAP) at T1-T3,T9,T10,mean pulmonary artery pressure (MPAP) at T1-T3,T9,T10,system vascular resistance index (SVRI) at T1-T10,pulmonary vascular resistance index (PVRI) at T1-T10,cardiac index (CI) at T7-T8,left ventricular stroke work index (LVSWI) and right ventricular stroke work index (RVSWI)at T7-T8 (P＜0.05).The incidences of sinus tachycardia and hypertension in group D were significantly reduced than in group C (P＜0.05).In both groups,glucose (Glu),cortisol (Cor),noradrenaline (NE) and epinephrine (E) increased significantly at T3,T8-T10 (P＜0.05).However,the value were lower in group D [Glu(6.7±0.8),(6.9±0.8),(6.8±0.8),(6.4±0.7) mmol/L.Cor (744±28),(834±46),(782±47),(733±40) μmol/L.NE (3 325±160),(3 866±221),(3 307±184),(3 153± 81) nmol/L.E (552±38),(652±41),(603±39),(558±43) nmol/L] compared with those in group C (P＜0.05).Consumption of fentanyl in group D was lower than that in group C (P＜0.05).Conclusions Intraoperative dexmedetomidine infusion could attenuate the hemodynamic and neuroendocrinal response and reduce the incidence of adverse events in patients undergoing OPCABG.
