右旋美托咪啶麻醉诱导用于冠状动脉旁路移植术临床效果分析

目的:对比研究麻醉诱导时联合应用右旋美托咪啶(dexmedetomidine)在冠状动脉旁路血管移植术(OPCABG)的临床效果。方法:36例拟行OPCABG的患者随机分为右旋美托咪啶组(D组)与对照组(C组)。D组于麻醉诱导前给予右旋美托咪啶负荷量1μg/kg进行麻醉诱导,给药时间>10min。C组采用0.9%氯化钠液对照。2组麻醉诱导方法和其他用药相同。记录麻醉诱导前(T1)、气管插管时(T2)、气管插管后即刻(T3)的血流动力学指标。术后镇痛均采用舒芬太尼,镇痛效果采用100mm视觉模拟评分(visual analog scale,VAS)法,术后镇静程度采用Remesay镇静评分。记录气管导管拔除时间、ICU停留时间、舒芬太尼应用总量、术后吗啡的额外需要量及术后并发症。结果:与C组比较,D组在麻醉诱导气管插管时平均动脉压(76±8)mmHg(1 mmHg=0.133 kPa)较C组(64±10)mm-Hg高,下降幅度小(P<0.05),气管插管后MAP及心率升高幅度较小(P<0.05)。ICU拔除气管导管后15 min、4 h及24 h的VAS评分2组差异无统计学意义。2组术后拔管时间、ICU停留时间、舒芬太尼总量、Remesay镇静评分、恶心呕吐的发生率及总住院时间差异无统计学意义。结论:麻醉诱导联合应用右旋美托咪啶于OPCABG患者具有更理想的血流动力学参数,提示右旋美托咪啶在OPCABG患者麻醉诱导中具有一定的临床应用价值。

The clinical effects of dexmedetomidine during anesthetic induction for patients undergoing off-pump coronary artery bypass grafting

Objective：To evaluate the clinical effects of dexmedetomidine combined with other anes-thetics during anesthetic induction for patients undergoing off-pump coronary artery bypass grafting（OPCAB）.Methods：Thirty-six patients scheduled for OPCABG were randomly devided into group dexmedetomidine（group D） and control group（group C）.Group D received dexmedetomidine 1.0 μg/kg over 10 min,and group C re-ceived placebo saline before anesthetic induction.The two group received the same method of anesthetic induc-tion.Hemodynamic variables were recorded at pre-induction（T1）,intubation（T2）,after tracheal intubation（T3）.Pain was measured using visual analog scale（VAS）,Remesay sedation scale was evaluated for sadition.The duration of tracheal intubation and intensive care unit,hospital length of stay and complications were recor-ded.Also,total sufentanil dosage and extra morphine dosage were calculated either.Results：Mean artery pres-sure（MAP） at intubation was significantly higher in Group D than Group C,The percent increase in MAP and HR due to tracheal intubation in Group D was significantly lower than that of Group C（P〈0.05）.There was no differences with VAS of 15min,4h and 24h after tracheal extubation.No differences between groups were not-ed for duration of tracheal intubation,ICU and hospital length of stay,total sufentanil dosage,sedation,and postoperative nausea and vomit.Conclusion：Dexmedetomidine can suppresses the decrease in blood pressure due to anesthetic induction and also blunts the cardiovascular response to tracheal intubation.Provide betterpain control,indicating that Dexmedetomidine can provide superior clinical effects in patients undergoing OPCAB.