右美托咪定对非体外循环冠状动脉旁路移植术中患者血流动力学的影响

目的：评价右美托咪定对非体外循环冠状动脉旁路移植术（OPCABG）中患者血流动力学的影响。方法选取2013年1～12月在我院择期行非体外循环冠状动脉旁路移植术的冠心病患者316例，采用随机数字表法分为两组（n=158）：对照组（A组）和右美托咪定组（B组）。两组患者均采用相同麻醉诱导及麻醉维持方法，右美托咪定组（B组）于麻醉诱导后先以1μg/（kg·10min）给予右美托咪定负荷剂量，然后以0.5μg/（kg·h）维持剂量输注至术毕，对照组（A组）输注等容量的生理盐水。分别于麻醉诱导前（T0）、切皮前（T1）、切皮时（T2）、劈胸时（T3）、搭桥前（T4）、搭桥时（T5）和手术结束时（T6）记录和测定心率（HR）、中心静脉压（CVP）、平均动脉压（MAP）、平均肺动脉压（MPAP）、肺动脉楔压（PAWP）、心排血量（CO）、外周循环阻力（SVR）、肺循环阻力（PVR）。结果两组患者性别构成、年龄、体重、身高、心功能、手术时间及麻醉时间差异均无统计学意义（P＞0.05），对照组T2、T3和T5测得HR、MAP较切皮前明显升高，差异有统计学意义（P＜0.05），与右美托咪定组比较，对照组T2、T3和T5各时间点测得HR、MAP、MPAP、SVR、PVR明显升高，差异有统计学意义（P＜0.05）。结论非体外循环冠状动脉旁路移植术中，给予右美托咪定1μg/（kg·10min）负荷剂量，继以0.5μg/（kg·h）维持剂量输注有助于维持患者血流动力学的稳定。

The effect of dexmedetomidine on hemodynamics in patients with off pump coronary artery bypass grafting

Objective To investigate the effect of dexmedetomidine on hemodynamics in patients with off pump coronary artery bypass grafting. Methods Three hundred and sixteen patients undergoing off pump coronary artery bypass grafting were randomly divided into two groups （n=158）： control group（group A） and dexmedetomidine group（group B）. After induction of anesthesia, a loading dose of dexmedetomidine 1 μ g/（kg·10min） was injected intravenously over 10 minutes, followed by infusion at 0.5 μg/（kg·h） until the end of operation in group D. While the equal volume of normal saline was given in group C. Heart rate, central venous pressure, mean arterial pressure, mean pulmonary arterial pressure, pulmonary artery wedge pressure, cardiac output, systemic vascular resistance and pulmonary vascular resistance were recorded and calculated at the time before anesthesia induction （To）, before skinincision （T,）, cutting skin （T2）, sternotomy （T3）, before bypass （T4）, bypassing （Ts）, and the end of operation （T6）. Results There was no significant difference in sex, age, weight, height, heart function, operation time and anesthetic time （P〈0.05）. In group A, heart rate, mean arterial pressure increased significantly （P 〈 0.05）. Compared with group A, heart rate, mean arteria]μ pressure, mean pulmonary arterial pressure, systemic vascular resistance and pulmonary vascular resistancethe were significantly lower in group B （P〈0.05）. Conclusion During off pump coronary artery bypass grafting, dexmedetomidine infused at 0.5 μ g/（kg · h） after a loading dose of 1 tμ g/（kg· 10min） is useful in maintaining hemodynamics stable.