瑞芬太尼复合右美托咪定在非体外循环冠状动脉旁路移植术中的麻醉效果

Anesthetic effect of remifentanil combined with dexmedetomidine on off-pump coronary artery bypass grafting

目的探讨瑞芬太尼复合右美托咪定在非体外循环冠状动脉旁路移植术(OPCABG)中的麻醉效果。方法选取2019年1月至2020年1月于首都医科大学附属北京安贞医院接受OPCABG的患者120例,采用随机数字表法分为观察组和对照组,各60例。对照组采用舒芬太尼麻醉方案,观察组采用瑞芬太尼复合右美托咪定麻醉方案。比较2组患者入室镇静状态(T_(0))、麻醉诱导插管后(T_(1))、冠状动脉旁路移植时(T_(2))、关闭胸腔时(T_(3))及手术结束时(T_(4))的心率及平均动脉压(MAP),术前、术后24 h与术后48 h心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)水平,以及术后转归情况。结果观察组T_(0)~T_(4)各时点心率、MAP差异均无统计学意义(均P>0.05);对照组T_(2)、T_(3)时点心率均低于T_(0)、T_(1)时点,T_(3)时点MAP高于T_(1)时点,差异均有统计学意义(均P<0.05)。观察组T_(2)、T_(3)、T_(4)时点心率均高于对照组,差异均有统计学意义(均P<0.05),2组T_(0)~T_(4)时点MAP差异均无统计学意义(均P>0.05)。观察组术后24、48 h cTnI、CK-MB水平均低于对照组[术后24 h:(0.21±0.10)μg/L比(0.61±0.22)μg/L、(28±12)U/L比(54±20)U/L;术后48 h:(0.10±0.08)μg/L比(0.45±0.20)μg/L、(24±12)U/L比(46±17)U/L],差异均有统计学意义(均P<0.001)。观察组苏醒时间、拔管时间、重症监护病房(ICU)停留时间、住院时间均短于对照组,差异均有统计学意义(均P<0.05)。结论在OPCABG中,瑞芬太尼复合右美托咪定能够稳定患者血流动力学,减轻心肌损伤,实现早期苏醒与拔管的临床目的,有效缩短ICU停留时间与住院时间,具有良好的麻醉效果。

Objective To explore the anesthetic effect of remifentanil combined with dexmedetomidine on off-pump coronary artery bypass grafting(OPCABG).Methods From January 2019 to January 2020,120 patients undergoing OPCABG in Beijing Anzhen Hospital,Capital Medical University were selected.They were randomly divided into control group and observation group,with 60 cases in each group.The control group was treated with sufentanil anesthesia,and the observation group was treated with remifentanil combined with dexmedetomidine anesthesia.The heart rate and mean arterial pressure(MAP)at sedation after entering the room(T_(0)),after anesthesia induction and intubation(T_(1)),at coronary artery bypass grafting(T_(2)),at closing the chest(T_(3))and operation ending(T_(4)),cardiac troponin I(cTnI)and creatine kinase isoenzyme(CK-MB)levels before operation,24 h after operation and 48 h after operation,and postoperative outcomes of patients were compared between the two groups.Results There were no significant differences in heart rate and MAP at T_(0)-T_(4) in observation group(all P>0.05);in control group,heart rate at T_(2) and T_(3) was lower than that at T_(0) and T_(1),and MAP at T_(3) was higher than that at T_(1)(all P<0.05).Heart rates at T_(2),T_(3) and T_(4) in observation group were higher than those in control group(all P<0.05).There were no significant differences in MAP at T_(0)-T_(4) between the two groups(all P>0.05).The levels of cTnI and CK-MB at 24,48 h after operation in observation group were lower than those in control group[24 h after operation:(0.21±0.10)μg/L vs(0.61±0.22)μg/L,(28±12)U/L vs(54±20)U/L;48 h after operation:(0.10±0.08)μg/L vs(0.45±0.20)μg/L,(24±12)U/L vs(46±17)U/L](all P<0.001).The awaking time,extubation time,intensive care unit(ICU)residence time,and length of stay in observation group were shorter than those in control group(all P<0.05).Conclusion In OPCABG,the combined application of remifentanil and dexmedetomidine can stabilize hemodynamics of patients,reduce myocardial damage,achieve the clinical purpose of early awaking and extubation,effectively shorten ICU residence time and length of stay,and has good anesthetic effect.