右美托咪定对体外循环冠状动脉旁路移植术中血流动力学心肌酶的影响

The effects of dexmedetomidine on perioperative hemodynamics and myocardial enzyme in patients after on-pump coronary artery bypass grafting

目的观察应用右美托咪定对体外循环下冠状动脉旁路移植术患者血流动力学和心肌酶的影响。方法择期体外循环下行冠状动脉旁路移植术的患者60例,随机分为右美托咪定组(n=30)和对照组(n=30)。两组患者采用相同麻醉诱导和维持方法,右美托咪定组于麻醉诱导后予以0.5μg/(kg·h)输注至术毕,对照组输注等量的生理盐水。分别于入室后(T0)、麻醉诱导后(T1)、切皮时(T2)、心肺转流结束时(T3)和手术结束时(T4),观察记录心率(HR)、收缩压(SBP)和舒张压(DBP)、心排量(CO)、外周循环阻力(SVR)和肺循环阻力(PVR),血管活性药物的用量。并分别测定T1~T4、术后6 h(T5)、术后24 h(T6)的血浆肌酸激酶同工酶(CKMB)、肌钙蛋白T(c Tn T),观察记录术中心血管不良反应的发生情况。结果组间比较,两组患者在各时间点心率、血压均没有明显差异。组内比较,与T0时点比较,T1时点两组HR、SBP和DBP明显降低(P<0.05)。T3、T4时右美托咪定组SVR和PVR均低于对照组,组间比较有统计学意义(P<0.05)。与T1、T2比较,T3~T6时两组患者CKMB、c Tn T明显升高(P<0.05),右美托咪定组低于对照组,组间比较差异有统计学意义(P<0.05)。两组均未出现严重不良反应。结论体外循环下行冠状动脉旁路移植术的患者术中输注0.5μg/(kg·h)右美托咪定,可稳定血流动力学,在一定程度上降低对心肌酶的影响。

Objective To observe the effects of dexmedetomidine on hemodynamics and myocardial enzyme in patients after on-pump coronary artery bypass grafting（ CABG）. Methods Sixty patients with coronary heart disease were divided into dexmedetomidine group（ group D） and control group（ group C） randomly. Two groups of patients were applied with the same anesthesia induction and maintenance methods. In group D after anesthesia induction,dexmedetomidine infusion was started by 0.5 μg/（ kg·h） during the operation. While the group C received the same volume of saline. HR,MAP,CO,SVR,PVR and vascular active drug dosage at different time points,including room enter（ T0）,induction of anesthesia（ T1）,skin incision（ T2）,the end of CPB（ T3）,the end of the surgery（ T4） were recorded. Blood was sampled for CKMB,c Tn T at T1,T2,T3,T4,6 h post-surgery（ T5）,and 24 h post-surgery（ T6）. The adverse reactions were recorded. Results Compared between the two groups,patients at various time points had no significant differences in heart rates and blood pressure. During operations,HR,SBP and DBP at T1,compared with those at T0 decreased obviously（ P 0.05）. At time points of T3 and T4,SVR and PVR were lower in group D than those in group C,there were significant differences between the groups（ P 0.05）. CKMB,c Tn T at T3 ~ T6,compared with those at T1 and T2,increased significantly in both groups（ P 0.05）. CKMB,c Tn T in group D were lower than those in group C（ P 0.05）. No serious adverse reactions occurred in both groups. Conclusion Injection of 0.5 μg/（ kg·h） dexmedetomidine during on-pump CABG can help to maintain stable hemodynamics,as well as decreasing adverse impacts in myocardial enzyme to a certain extent.