右美托咪定联合氯胺酮对心脏外科快速康复的作用及影响

Effect of Dexmedetomidine Combined with Ketamine on Rapid Rehabilitation of Cardiac Surgery

目的:探讨右美托咪定与氯胺酮联合麻醉对心脏外科患者快速康复的作用及相关影响。方法:选取择期体外循环下行手术治疗的成人心脏病患者160例,均为本院2014年9月-2016年9月收治,电脑随机分组,即N组(常规麻醉组)、K组(氯胺酮持续泵注组)、D组(右美托咪定持续泵注组)、K-D组(氯胺酮-右美托咪定联合泵注组)各40例。对比右美托咪定与氯胺酮联合麻醉效果。结果:四组c Tn I及CK-MB血浆浓度第2、3天均有升高,但K-D组明显低于其他三组,差异有统计学意义(P<0.05)。K-D组ICU入住时间(5.2±0.4)d显著低于N组(7.9±0.9)d、K组(7.8±0.5)d、D组(7.6±0.8)d,差异均有统计学意义(P<0.05);K-D组拔气管导管时间(6.1±0.5)h显著低于N组(8.8±0.4)h、K组(7.5±0.4)h、D组(7.2±0.7)h,差异均有统计学意义(P<0.05);K-D组心脏自动复跳显著低于N组、K组、D组,差异有统计学意义(P<0.05);K-D组住院时间显著低于N组、K组、D组,差异有统计学意义(P<0.05)。K-D组正性肌力药使用率、临床起搏器安装率、房颤率均低于N组、K组、D组,差异均有统计学意义(P<0.05)。术后K组、D组、K-D组疼痛评分分别为(2.58±0.80)分、(2.87±0.70)分、(1.36±0.60)分均低于N组(3.74±0.70)分,其中又以K-D组为最低,差异均有统计学意义(P<0.05)。K-D组患者的MAP下降率、心动过缓率、躁动或谵妄率均显著低于N组、K组、D组,差异均有统计学意义(P<0.05)。结论:针对临床收治的心脏外科手术患者,采用右美托咪定与氯胺酮联合麻醉,可对缺血再灌注损伤加以预防,能缩短ICU入住时间、拔气管导管时间、住院时间,降低不良时间的发生率,促心脏手术康复加速。

Objective:To investigate the effect of Dexmedetomidine combined with Ketamine on rapid rehabilitation of cardiac surgery and its related effects.Method:A total of 160 patients with adult heart disease undergoing elective cardiopulmonary bypass were selected from September 2014 to September 2016,and the patients were randomly divided into N group(conventional anesthesia group),K group(Ketamine),D group(Dexmedetomidine),K-D group(Ketamine+Dexmedetomidine),40 cases in each group.The anesthesia effect of Dexmedetomidine combined with Ketamine of four groups were compared.Result:Plasma cTnI and CK-MB of four groups increased on the 2nd and 3rd days,but K-D group was significantly lower than those the other three groups(P<0.05).The ICU stay time of K-D group(5.2±0.4)d was significantly lower than that of N group(7.9±0.9)d,K group(7.8±0.5)d,D group(7.6±0.8)d,the duration of tracheal intubation of K-D group(6.1±0.5)d was significantly lower than that of N group(8.8±0.4)d,K group(7.5±0.4)d,D group(7.2±0.7)d,the resuscitation rate was significantly lower than that of N group,K group and D group(P<0.05).The length of stay in hospital of K-D group was significantly lower than that of N group,K group and D group(P<0.05).K-D group inosine use rate,clinical pacemaker installation rate,atrial fibrillation rate were lower than those of N group,K group,D group,the difference was significant(P<0.05).After surgery,pain scores of K group,D group and K-D group were(2.58±0.80)points,(2.87±0.70)points,(1.36±0.60)points was lower than that of N group(3.74±0.70)points,K-D group was the lowest,the difference was significant(P<0.05).The rates of MAP decline,bradycardia,agitation or delirium in K-D group were significantly lower than those in N group,K group and D group(P<0.05).Conclusion:The combination of Dexmedetomidine and Ketamine can be used to prevent ischemia-reperfusion injury in patients with cardiac surgery.It can shorten the time of ICU stay,the duration of endotracheal tube,the time of hospitalization,and the time of lowering the bad time,incidence of accelerated cardiac surgery.