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被引量：21

Effects of different doses of dexmedetomidine on hemodynamics during anesthesia induction

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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55~80kg,BMI 18.5～24.5kg/m^2,ASAⅡ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0.3μg/kg组(D3组)、右美托咪定0.6μg/kg组(D6组)和右美托咪定0.9μg/kg组(D9组)。D3组、D6组和D9组分别于麻醉诱导前10min静脉输注右美托咪定0.3、0.6、0.9μg/kg,输注时间10min。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(T_0)、输注5min(T_1)、输注完毕(T_2)、气管插前即刻(T_3)、气管插管后1min(T_4)、气管插管后3min(T_5)、气管插管后5min(T_6)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T_0时比较,T_1—T_6时D6组和D9组HR明显减慢(P <0.05),T_1时D9组SBP、DBP明显升高,T_3时三组SBP、DBP明显降低(P <0.05),T_4时D3组HR明显增快(P <0.05)。与T_3时比较,T_4和T_5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T_3时SBP、DBP明显升高(P <0.05),T_4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0.9μg/kg的负荷量比较,麻醉诱导前10min静脉输注0.6μg/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。 Objective 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 statusⅡ orⅢ,NYHA Ⅱ orⅢand 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 0.9μg/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 and10 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.ResultsCompared 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 0.9μg/kg,dexmedetomidine 0.6μg/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.

作者吴迷迷王世端夏婧柳国强梁永新 WU Mimi;WANG Shiduan;XIA Jing;LIU Guoqiang;LIANG Yongxin(Department of Anesthesiology,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区青岛大学附属医院麻醉科

出处《临床麻醉学杂志》 CAS CSCD 北大核心 2018年第9期882-885,共4页 Journal of Clinical Anesthesiology

关键词右美托咪定冠状动脉搭桥术心肺转流血流动力学 Dexmedetomidine Coronary artery bypass grafting Cardiopulmonarybypass Hemodynamics

分类号 R614 [医药卫生—麻醉学]

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参考文献2

1江岩,王世端,刘爱杰,滕如阳,孙健,刘文义,初春芹.右美托咪啶复合小剂量舒芬太尼对非体外循环冠状动脉旁路移植术患者麻醉诱导期间血液动力学的影响[J].中华麻醉学杂志,2011,31(9):1093-1095. 被引量：21
2尹加林,戴琼艳,谢欣怡,徐亚杰,孙凡,斯妍娜,鲍红光.麻醉恢复期的管理专辑三种不同剂量右美托咪定对全麻鼻内镜手术围拔管期应激反应的影响[J].临床麻醉学杂志,2014,30(10):941-945. 被引量：35

二级参考文献15

1李民,张利萍,吴新民.右美托咪啶在临床麻醉中应用的研究进展[J].中国临床药理学杂志,2007,23(6):466-470. 被引量：483
2Engoren M,Luther G,Fenn-Buderer N.Acomparison of fentanyl,sufentanil,and remifentanil for fast-track cardiac anesthesia.Anesth Analg,2001,93(8):859-864.
3Khan ZP,Ferguson CN,Jones RM.Alpha-2 and imidazoline recptor agonists.Their pharmacology and therapeutic role.Anaesthesia,1999,54(2):146-165.
4Ebert TJ,Hall JE,Barney JA,et al.The affects of increasing plasma concentrations of dexmedetomidine in humans.Anesthesiology,2000,93(3):382-394.
5Menda F,Koner O,Sayin M,et al.Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG.Ann Card Anaesth,2010,13(1):16-21.
6Cooper RM, O Sullivan E, Popat M, et al. Difficult Airway Society guidelines for the management of tracheal extuhation. Anaesthesia, 2012, 67(3):318-340.
7Turan G, Ozgultekin A, Turan C, et al. Advantageous effects of dexmedetomidine on haemodynamic and recovery responses during extubation for intracranial surgery. Eur J Anaesthesiol, 2008, 25(10):816-820.
8Zamora Lozano J, Cruz Villasenor JA, Rodriguez Reyes J, et al. [Comparison of topical, intravenous, and intracuff lido- caine for reducing coughing after extubation during emergence from general anesthesia]. Rev Esp Anestesiol Reanim, 2007, 54(10) :596601.
9Sa{arinejad MR, Hosseini SY. Safety and e{ficacy of tramadol in the treatment of idiopathic detrusor overactivity: a double- blind, placebo-controlled, randomized study. Br J Clin Phar- macol, 2006, 61(4):456 463.
10Jakob SM, Ruokonen E, Grounds RM, et al. Dexmedetomi- dine vs midazolam or propofol for sedation during prolonged mechanical ventilation: two randomized controlled trials. JA- MA, 2012, 307(11):1151-1160.