不同剂量右美托咪定对冠状动脉搭桥术患者麻醉诱导期间血流动力学指标的影响

Effects of different doses of Dexmedetomidine on hemodynamics during anesthesia induction in patients undergoing coronary artery bypass grafting

目的探讨不同剂量右美托咪定对冠状动脉搭桥术患者麻醉诱导期间血流动力学指标的影响。方法选择2018年5月至2019年5月期间新乡医学院第一附属医院拟行非心肺转流冠状动脉搭桥术患者69例,按随机数字表法分为A、B、C组,每组23例。所有患者均在麻醉诱导前10 min静脉滴注不同剂量的右美托咪定,输注时间均为10 min。A组给予右美托咪定0.25μg/kg,B组为0.5μg/kg,C组为1.0μg/kg。麻醉诱导给予患者1.5 mg/kg利多卡因,0.08 mg/kg咪达唑仑,0.5μg/kg舒芬太尼,3~5 min。将麻醉诱导过程分为右美托咪定静脉滴注前(T0)、静脉滴注5 min(T1)、完成静脉滴注(T2)、气管插管时(T3)、气管插管1 min(T4)、气管插管3 min(T5)及气管插管5 min(T6),记录每个时间点各组患者的血压、心率、静脉血中的血糖、去甲肾上腺素、肾上腺素水平,以及不良反应发生情况。结果与T0时比较,B、C两组患者在T1~T6时间点的心率明显降低,C组患者的血压在T1时明显升高,各组患者的血压在T3时出现明显降低,A组心率在T4时明显升高,差异均有统计学意义(均P<0.05)。与T3时比较,A组在T4~T6时的心率和血压明显升高,差异均有统计学意义(均P<0.05)。与T0时比较,各组患者T6时血糖、去甲肾上腺素及肾上腺素水平差异均无统计学意义(均P>0.05)。与A组比较,B组、C组低血压发生率降低,差异有统计学意义(P<0.05)。与C组比较,A组与B组的高血压、呼吸抑制及心动过缓发生率降低,差异均有统计学意义(均P<0.05)。结论基于利多卡因、咪达唑仑和舒芬太尼一定剂量基础上,冠状动脉搭桥术麻醉诱导前选择剂量为0.5μg/kg右美托咪定可稳定患者的血压、心率与应激反应,降低麻醉药物引发的低血压风险。

Objective To investigate the effects of different doses of Dexmedetomidine on hemodynamics during anesthesia induction in patients undergoing coronary artery bypass grafting. Methods A total of 69 patients with non-cardiac bypass coronary artery bypass grafting were enrolled in the First Affiliated Hospital of Xinxiang Medical College from May 2018 to May 2019. The random number table method was applied to divide the patients into groups A,B,and C,with 23 patients in each group. The anesthetic dose of Dexmedetomidine was 0. 25 μg/kg in group A,0. 5 μg/kg in group B,and 1. 0 μg/kg in group C. All patients received different doses of Dexmedetomidine intravenously 10 min before anesthesia induction,and the infusion time was 10 min. The anesthesia induction process was divided into Dexmedetomidine before infusion(T0),infusion for 5 min(T1),completion of infusion(T2),endotracheal intubation(T3),endotracheal intubation 1 min(T4),tracheal intubation 3 min(T5),tracheal intubation 5 min(T6),blood pressure,heart rate of each group of patients at each time point,blood glucose,norepinephrine,adrenaline levels and dysfunction in patients with venous blood at T0 and T6 reaction. Results Compared to T0,the heart rate of patients in group B and C decreased significantly at the time of T1-T6,the blood pressure of group C was significantly higher at T1,the blood pressure of the three groups decreased significantly at T3,the heart rate of group A was significantly accelerated at T4,the difference was statistically significant(P<0. 05). Compared to T3,the heart rate of group A was significantly increased at T4-T6,and the blood pressure was significantly increased,the difference was statistically significant(P<0. 05). There were no significant differences in blood glucose,norepinephrine and adrenaline levels between T3 and T0 in the three groups(P>0. 05). Compared to group A,the incidence of hypotension in group B and group C decreased,and the difference was statistically significant(P<0. 05). Compared to group C,the incidence of hypertension,respiratory depression,and bradycardia in group A and group B decreased,and the difference was statistically significant(P<0. 05). Conclusion Based on certain doses of Lidocaine,Midazolam and Sufentanil,Dexmedetomidine can stabilize the blood pressure,heart rate and stress response of patients before anesthesia induction,reduce the risk of hypotension caused by anesthetics,and ensure the smooth implementation of coronary artery bypass surgery.