右美托咪啶联合地佐辛术后镇痛对非体外循环冠脉搭桥患者术后心肌酶谱的影响

Effect of dexmedetomidine combined with dezocine for post operative analgesiaon myocardial enzymes in patients undergoing off-pump coronary artery bypass graft

目的:探讨右美托咪啶联合地佐辛术后镇痛对非体外循环冠脉搭桥术(OPCABG)患者的心肌保护作用。方法:择期全身麻醉OPCABG患者60例,ASAⅡ~Ⅲ级,随机分为右美托咪啶联合地佐辛组(A组)30例,地佐辛组(B组)30例。A组诱导时给予地佐辛0.1 mg/kg,术中维持加用右美托咪啶0.5μg/(kg·h),术后镇痛配方:地佐辛1.0 mg/kg,右美托咪啶4μg/kg,昂旦司琼0.2 mg/kg,加生理盐水至156 ml,皮下镇痛,速度2 ml/h,负荷量2 ml,每小时极量8 ml,自控镇痛(PCA)单次量1.0 ml,锁时10 min。B组诱导时给予地佐辛0.1 mg/kg,术后镇痛配方:地佐辛1.0mg/kg,昂旦司琼0.2 mg/kg,加生理盐水至156 ml,皮下镇痛,速度2 ml/h,负荷量2 ml,每小时极量8 ml,PCA单次量1.0 ml,锁时10 min。其余治疗两组相同。观察比较两组患者手术前和手术后24 h乳酸脱氢酶(LDH)、肌酸激酶同工酶(CK-MB)以及肌酸激酶(CK)值及麻醉诱导前、拔管后6 h、12 h、24 h、48 h、72 h时的收缩压(SBP)、舒张压(DBP)和心率(HR)、血氧饱和度(Sp O2)的变化,比较术后12 h、24 h、36 h、48 h、72 h患者的疼痛指标Ramsay评分,镇痛指标视觉模拟评分法(VAS)和术后72 h内不良反应发生情况。结果:A组患者手术后LDH、CK-MB以及CK数值明显低于B组,差异有统计学意义(P<0.05)。两组麻醉诱导前、拔管后各时间点的SBP、DBP、HR和Sp O2的变化差异无统计学意义(P>0.05)。两组患者术后各时间点的Ramsay评分和VAS评分以及术后24 h,48 h,72 h的累计有效按压次数差异均无统计学意义(P>0.05)。A组患者的胃肠道不良反应及躁动例数少于B组,差异有统计学意义(P<0.05)。结论:右美托咪定联合地佐辛用于全身麻醉OPCABG患者具有一定心肌保护作用,术后镇痛效果确切且不良反应少。

Objective To investigate the myocardial protection of dexmedetomidine combined with dezocinefor postoperative analgesiain the off-pump coronary artery bypass grafting（ OPCABG）. Method Sixty patients with ASA ⅡorⅢscheduled for OPCABG were randomly divied into dexmedetomidine combined with dezocine group（ group A） and dezocine group（ group B） with30 cases each. The patients in group B were given dezocine 0. 1 mg / kg when induction of anesthesia. Postoperative analgesia formula：dezocine 1. 0 mg / kg,ondansetron 0. 2 mg / kg,plus with 0. 9% Na Cl to 156 ml,used for subcutaneous analgesia,back-ground infusion of 2 ml with 2 ml bolus,with the maximum dose of 8 ml each hour and 1. 0ml single dose,and with 10 min lockout interval. The patients in group A were given dezocine 0. 1 mg / kg when induction of anesthesia. Intraoperative maintain with dexmedetomidine of 0. 5 μg /（ kg·h）. Postoperative analgesia formula was the same as group B except plus the dexmedetomidine about 4 μg / kg. The rest of treatments were same inthe two groups. To observe and compare the values of lactate dehydrogenase（LDH）,creatine phosphokinase MB（CK-MB）and creatine kinase（CK）between two groups at two time-before surgery and 24 h after surgery. In the meantime,compare the values of systolic blood pressure、diastolic blood pressure、heart rate and blood oxygen saturation before anesthesia and 6,12,24,48,72 h after extubation. In addition to,sedation level was measured after surgery by Ramsay method and pain intensity was assessed by the VAS score at 12,24,36,48,72 h after surgery and adverse reactions within 72 h after surgery were also recorded. Results Values of lactate dehydrogenase（ LDH）,creatine phosphokinase MB（ CK-MB） and creatine kinase（ CK） after surgery in group A were less than group B obviously,there were significant differences between two groups（ P 〈0. 05）. The values of Systolic blood pressure、Diastolic blood pressure、Heart rate and Blood oxygen saturation before anesthesia and 6,12,24,48,72 h after extubation were no difference（ P 〉0. 05）. And differences were not found in Ramsay score,VSA and the effective pressing times at 24,48,72 h after surgery between the two groups（ P〉 0. 05）. But patients in group A were found less gastrointestinal adverse reactions and less restlessness than group B（ P 〈0. 05）. Conclusion There are some myocardial protective effect aboutdexmedetomidine combined with dezocine in the off-pump coronary artery bypass grafting,andthe analgesic effects are exact without many adverse reactions.