文章摘要
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的影响
Effects of different doses of dexmedetomidine on hemodynamics during anesthesia induction
  
DOI：10.12089/jca.2018.09.012
中文关键词: 右美托咪定  冠状动脉搭桥术；心肺转流  血流动力学
英文关键词: Dexmedetomidine  Coronary artery bypass grafting  Cardiopulmonary bypass  Hemodynamics
基金项目:
作者单位E-mail
吴迷迷 266003,青岛市,青岛大学附属医院麻醉科  
王世端 266003,青岛市,青岛大学附属医院麻醉科 wangsd1958@163.com 
夏婧 266003,青岛市,青岛大学附属医院麻醉科  
柳国强 266003,青岛市,青岛大学附属医院麻醉科  
梁永新 266003,青岛市,青岛大学附属医院麻醉科  
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中文摘要:
      
目的 比较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的影响。

方法 选择拟行非心肺转流冠状动脉搭桥术患者75例, 男54例, 女21例, 年龄45～70岁, 体重55～80 kg, BMI 18.5～24.5 kg/m2, ASA Ⅱ 或 Ⅲ 级, 左室射血分数≥45％, NYHA心功能分级 Ⅱ 或 Ⅲ 级。采用随机数字表法将患者随机分为三组: 右美托咪定0.3 μg/kg组(D3组)、右美托咪定0.6 μg/kg组(D6组)和右美托咪定0.9 μg/kg组(D9组)。D3组、D6组和D9组分别于麻醉诱导前10 min静脉输注右美托咪定0.3、0.6、0.9 μg/kg, 输注时间10 min。麻醉诱导后, BIS≤55时行气管插管后机械通气。记录右美托咪定输注前(T0)、输注5 min(T1)、输注完毕(T2)、气管插前即刻(T3)、气管插管后1 min(T4)、气管插管后 3 min(T5)、气管插管后 5 min(T6)时的HR、SBP、DBP;记录麻醉诱导期间的低血压、高血压、心动过缓和呼吸抑制等不良事件发生情况。

结果 与T0时比较, T1—T6时D6组和D9组HR明显减慢(P < 0.05), T1时D9组SBP、DBP明显升高, T3时三组SBP、DBP明显降低(P < 0.05), T4时D3组HR明显增快(P < 0.05)。与T3时比较, T4和T5时D3组HR明显增快, SBP、DBP明显升高(P < 0.05)。与D3组比较, D6组和D9组T3时SBP、DBP明显升高(P < 0.05), T4时HR明显减慢(P < 0.05)。与D3组比较, D6组和D9组发生低血压明显减少, D9组发生高血压, 心动过缓和呼吸抑制明显增多(P < 0.05)。与D6组比较, D9组发生高血压、心动过缓和呼吸抑制明显增多(P < 0.05)。

结论 与右美托咪定0.3和0.9 μg/kg的负荷量比较, 麻醉诱导前10 min静脉输注0.6 μg/kg右美托咪定更有助于稳定冠状动脉搭桥术患者麻醉诱导期间的血流动力学, 有利于维持心肌氧供需平衡。
英文摘要:
      
Ojective To evaluate the effects of different doses of dexmedetomidine on hemodynamics during anesthesia induction in patients undergoing coronary artery bypass grafting.

Methods Seventy-five patients 54 males and 21 females, aged 45 - 70 years, weighing 55 - 80 kg, BMI 18.5 - 24.5 kg/m2, ASA physical status Ⅱ or Ⅲ, NYHA Ⅱ or Ⅲ and left ventricular ejection fraction≥ 45％, undergoing off-pump coronary artery bypass grafting, were randomly divided into groups D3, D6 and D9 using a random number table. Dexmedetomidine 0.3, 0.6 and 0.9 μg/kg were infused intravenously for 10 min before induction of anesthesia in groups D3, D6 and D9, respectively. After induction of anesthesia, the patients were tracheally intubated and mechanically ventilated when BIS value≤55. HR, SBP and DBP were recorded before dexmedetomidine infusion (T0), 5 and 10 min after dexmedetomidine infusion (T1 - T2), immediately before intubation (T3) and 1, 3, 5 min after intubation (T4-T6). The incidences of adverse cardiovascular events (hypotension, hypertension and bradycardia) and respiratory depression were also recorded during anesthesia induction.

Results Compared with T0, HR was significantly decreased at T1 - T6 in groups D6 and D9 (P < 0.05), SBP and DBP were significantly increased at T1 in group D9 (P < 0.05), while decreased at T3 in all three groups (P < 0.05), and HR was increased at T4 in group D3 (P < 0.05). Compared with T3, the HR, SBP and DBP were significantly increased at T4 and T5 in group D3 (P < 0.05). Compared with group D3, SBP and DBP of groups D6 and D9 were significantly increased at T3 (P < 0.05), while HR was decreased at T4 (P < 0.05). The rate of hypotension was significantly lower in groups D6 and D9 than that in group D3 (P < 0.05). Besides, the incidence of hypertension, bradycardia and respiratory depression were significantly increased in group D9 than those in groups D3 and D6 (P < 0.05).

Conclusion Compared with 0.3 and 0.9 μg/kg, dexmedetomidine 0.6 μg/kg intravenous infusion is better to keep the stability of hemodynamics and the balance of myocardial oxygen delivery and consumption during anesthesia induction in patients undergoing coronary artery bypass grafting.
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