右美托咪定对成人体外循环心脏术后心律的影响

目的评价右美托咪定对成人体外循环心脏手术后心律的影响。方法2016年1月至2020年5月在我院接受体外循环下心脏手术的成年患者121例,随机数字表法分为试验组60例和对照组61例,对照组予以体外循环心脏术后常规治疗方案,试验组在对照组治疗方案上加用右美托咪定0.5μg/(kg·h)持续泵入至术后48 h。观察术后24、48小时不同类型心律失常发生率,术后不同时间点的肌酸激酶同工酶(CK-MB)、超敏肌钙蛋白(cTnT)浓度、血流动力学指标及ICU住院时间。结果与对照组相比,试验组在术后24、48小时内快速型心律失常的发生率、术后12小时CK-MB浓度、24小时cTnT血浆浓度及ICU住院时间均低于对照组;术后12小时和24小时试验组的HR、平均动脉压(MAP)及中心静脉压(CVP)低于对照组;术后48小时HR及CVP低于对照组,差异均有统计学意义(P<0.05)。缓慢型心律失常发生率及动脉乳酸水平两组差异无统计学意义(P>0.05)。结论右美托咪定可降低成人体外循环心脏术后心律失常的发生率,促进血流动力学稳定,减少ICU住院时间。

The effect of dexmedetomidine on postoperative arrhythmia in adult patients undergoing cardiac surgery with cardiopulmonary bypass:a single-blind randomized controlled trial

Objective To evaluate the efficacy and safety of dexmedetomidine for postoperative arrhythmia in patients undergoing cardiac surgery with cardiopulmonary bypass.Methods One hundred and twenty-one participants with cardiopulmonary bypass from January 2016 to May 2020 in our hospital were randomly divided into trial group(n=60)and control group(n=61).The control group received routine therapy after cardiopulmonary bypass while the trial group was given dexmedetomidine 0.5μg/(kg·h)combined with routine therapy.The ratio of arrhythmia within 24 and 48 hours after surgery is the primary outcome.The levels of CK-MB and cTnT,hemodynamic index and length of stay in ICU were also compared between the two groups.Results Compared with the control group,the ratio of tachyarrhythmia within 24 and 48 hours after surgery,levels of CK-MB at 12 hours and cTnT at 24 hours after surgery,and length of stay in ICU in the trial group were significantly decreased(P<0.05).The heart rate(HR),mean blood pressure(MBP)and central venous pressure(CVP)after 12 and 24 hours of operation in the trial group were lower than those in the control group(P<0.05).There was no significant differences in the incidence rates of bradycardia and level of Lac between two groups(P>0.05).Conclusion Dexmedetomidine can reduce the incidence of postoperative arrhythmia caused by with cardiopulmonary bypass and maintain the hemodynamic.It also shorten the length in ICU.