右美托咪啶持续输注对心脏手术患者麻醉效果和血流动力学的影响

Influence of continuous infusion of dexmedetomidine on the anesthetic effect and hemodynamics of patients with cardiac surgery

目的探讨右美托咪啶持续输注对心脏手术患者麻醉效果和血流动力学的影响。方法全麻下心脏手术患者55例随机分为2组,右美托咪啶组(n=27)静脉输注右美托咪啶,对照组(n=28)注射等剂量生理盐水。2组麻醉诱导和麻醉维持方法相同。观察输注右美托咪啶前即刻(T1)、输注右美托咪啶后5 min(T2)、后10 min(T3)、麻醉诱导后3 min(T4)、气管插管即刻(T5)、插管后5 min(T6)和10 min(T7)时收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)和脑电双频指数(BIS)变化,并对比2组气管导管移除时间、导管拔除时RAMSAY镇静评分、ICU停留时间和不良反应。结果 T2、T3时右美托咪啶组DBP、MAP与T1比较无显著差异(P>0.05),HR呈下降趋势,但差异无统计学意义(P>0.05);T6、T7时右美托咪啶组SBP与T5时相比,差异无统计学意义(P>0.05)。对照组T6、T7时SBP值较T5时显著升高(P<0.05或P<0.01)。插管期间,除T5时SBP和HR外,2组各时间点差异无统计学意义(P>0.05)。与T1时比较,右美托咪啶组BIS值在T2、T3时显著下降(P<0.01),对照组变化差异无统计学意义(P>0.05)。麻醉诱导期间,2组BIS值较T3时均显著下降(P<0.01)。气管导管拔除时RAMSAY镇静评分,右美托咪啶组显著高于对照组(P<0.05);部分患者出现心动过缓、低血压等不良反应,但2组差异无统计学意义(P>0.05)。结论右美托咪啶持续输注用于心脏手术,能稳定患者围术期血流动力学,一定程度抑制气管插管等手术操作引起的应激反应。

Objective To investigate the influence of continuous infusion of dexmedetomidine on the anesthetic effect and hemodynamics of patients with cardiac surgery. Methods Fifty- five patients with cardiac surgery by general anesthesia were randomly divided into dexmedetomidine group（ n= 27） treated with intravenous infusion of dexmedetomidine and control group（ n = 28） treated with the same dose of normal saline. The methods of anesthesia induction and anesthesia maintenance were the same in two groups. The changes of systolic blood pressure（ SBP）,diastolic blood pressure（ DBP）,mean arterial pressure（ MAP）,heart rate（ HR） and bispectral index（ BIS） in two groups were observed immediately before infusion of dexmedetomidine（ T1）,5 min（ T2） and 10 min（ T3）after infusion of dexmedetomidine,3 min after anesthesia induction（ T4）,immediately after tracheal intubation（ T5） as well as 5 min（ T6） and 10 min（ T7） after intubation,and time of tracheal tube to remove,RAMSAY sedation score on removal of the tube,length of stay in ICU and adverse reactions were compared. Results No significant differences were observed in dexmedetomidine group in comparing DBP and MAP at T2 and T3with that at T1（ P〉0. 05）,and HR showed a downward trend,but there was no significant difference（ P〉0. 05）. No significant difference was presented in dexmedetomidine group in comparing SBP at T6 and T7with that at T5（ P〉0. 05）. In control group,the SBP at T6 and T7increased significantly than that at T5（ P〈0. 05 or P〈0. 01）. Except for the SBP and HR at T5,there were no significant differences between two groups in the other indexes at each time point during intubation（ P〉0. 05）. In dexmedetomidine group,the BIS at T2 and T3decreased significantly in comparison to that at T1（ P〈0. 01）,whereas there was no significant difference in control group（ P〉0. 05）. The BIS in two groups decreased significantly during anesthesia induction than that at T3（ P〈0. 01）. RAMSAY sedation score on removal of the tube in dexmedetomidine group was significantly higher than that in control group（ P〈0. 05）. Some patients had adverse reactions such as bradycardia and hypotension,but there was no significant difference between two groups（ P〉0. 05）. Conclusion Continuous infusion of dexmedetomidine in cardiac surgery can stabilize the perioperative hemodynamics of patients and inhibit the stress reactions induced by surgical operations.