右美托咪定对心脏不停跳冠状动脉搭桥术麻醉诱导及术后转归的影响

Effect of Dexmedetomidine on anesthesia induction and outcomes in patients undergoing off-pump coronary artery bypass grafting

目的观察右美托咪定对不停跳冠状动脉搭桥术麻醉诱导及术后转归的影响。方法选取择期心脏不停跳冠状动脉搭桥手术患者61例,随机分为对照组(C组,n=30)和右美托咪定组(D组,n=31)。D组于诱导前15 min给予右美托咪定0.6μg/kg,继之0.4μg/(kg·h)持续输注至手术结束;C组给予等体积生理盐水输注。麻醉诱导采用咪达唑仑0.02 mg/kg、初始丙泊酚靶控输注(TCI)浓度1.0μg/ml,每隔1 min增加0.3μg/ml,至意识消失,给予舒芬太尼0.8～1.0μg/kg、罗库溴铵0.6～0.9 mg/kg,肌松满意进行插管。记录入室(T_0)、给予负荷量15 min(T_1)、意识消失时(T_2)、插管前(T_3)、插管1 min(T_4)、插管3 min(T_5)、插管5 min(T_6)的心率(HR)、平均动脉压(MAP)、每搏量(SV)、心输出量(CO)、心脏指数(CI)、脑电双频谱指数(BIS),以及T_2、T_3、T_6及手术结束时丙泊酚TCI效应室浓度、总剂量及血管活性药的使用量。记录术后苏醒时间、拔管时间、ICU驻留时间及出院时间。结果与C组比较,D组在T_2、T_3、T_6及手术结束时丙泊酚TCI效应室浓度、丙泊酚用量和血管活性药用量均降低(P <0.05),在C组中,与T3比较,T4时刻血流动力学指标升高(P <0.05)。D组各时间点(T4～T6)血流动力学指标与T3比较,差异无统计学意义(P>0.05)。D组ICU驻留时间和住院时间短于C组(P <0.05),两组拔管时间差异无统计学意义(P>0.05)。结论右美托咪定能够降低心脏不停跳冠状动脉搭桥患者麻醉诱导期丙泊酚TCI效应室浓度,减少丙泊酚和血管活性药的用量,有利于诱导期血流动力学稳定,并且与缩短ICU驻留时间和术后住院时间有关。

To observe the effect of Dexmedetomidine on anesthesia induction and outcomes in patients undergoing off-pump coronary artery bypass grafting.Methods A total of 61 ASA grade II or III patients scheduled for elective off-pump coronary artery bypass grafting(Off-pump CABG)were randomly allocated to receive Dexmedetomidine(group D,31 cases)or normal saline(group C,30 cases)before anesthesia induction.The patients in the group D received intravenous infusion of 0.6μg/kg Dexmedetomidine 15 min before anesthesia induction,followed by 0.4μg/(kg?h)continuous infusion until the end of surgery.The patients in the group C received an equal volume of saline infusion.Midazolam 0.02 mg/kg was used for anesthesia induction,the Propofol targetcontrolled infusion(TCI)concentration was initially set to 1.0μg/ml,and increased by 0.3μg/ml every 1 min until loss of consciousness(LOC),then Sufentanil 0.8-1.0μg/kg and Rocuronium 0.6-0.9 mg/kg were given for intubation.HR,MAP,SV,CO,CI and BIS were recorded at the time of baseline(T0),15 min after loading dose(T1),loss of consciousness(T2),before endotracheal intubation(T3),and 1,3 and 5 min after endotracheal intubation(T4,T5 and T6).The TCI effect-site concentration and total dosage of Propofol and vasoactive drug dosage were recorded at T2,T3,T6 and at the end of the operation.Postoperative recovery time,extubation time,ICU stay duration and hospitalization time were also recorded.Results Compared with the group C,the effect-site concentration of Propofol TCI and the dosage of Propofol were decreased at T2,T3,T6 and at the end of the operation(P<0.05),the dosages of vasoactive drugs in anesthesia induction were also decreased(P<0.05).In the group C,hemodynamic parameters were elevated at T4 compared with those at T3(P<0.05).In the group D the hemodynamic parameters at T4-T6 were not significantly different from those at T3(P>0.05).The ICU stay and the hospitalization time of the group D were significantly shorter than those in the group C(P<0.05).There was no significant difference in the extubation time between the two groups(P>0.05).Conclusions Dexmedetomidine can reduce the effect-site concentration of Propofol TCI,Propofol dosage and the dosages of vasoactive drugs,maintain the stability of hemodynamics during anesthesia induction in the patients undergoing off-pump coronary artery bypass grafting,moreover,it has a positive impact on the outcome by shortening ICU stay and hospitalization days.