右美托咪定对全麻低温心肺转流下冠状动脉旁路移植术围术期的心肌保护作用

发布时间：2018-05-11 15:32

本文选题：右美托咪定 + 冠状动脉旁路移植术　；参考：《临床麻醉学杂志》2015年05期

【摘要】：目的观察右美托咪定对全麻低温心肺转流(CPB)下冠状动脉旁路移植术患者围术期的心肌保护作用。方法择期行全麻低温CPB下冠状动脉旁路移植术患者80例,男67例,女13例。随机均分为右美托咪定组(A组)和对照组(C组)。在中心静脉置管后,A组静脉泵注右美托咪定4μg·kg-1·h-1持续15min后调节维持剂量0.7μg·kg-1·h-1直到手术结束,C组用同样方案静注等容量生理盐水。记录入室后(T0)、麻醉诱导后(T1)、切皮时(T2)、CPB终止时(T3)和手术结束时(T4)的HR、SBP、DBP和血管活性药物用量。测定T1~T4、术后6h(T5)和术后24h(T6)血浆肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、肾上腺素(E)和去甲肾上腺素(NE)浓度。结果与T0时比较,T1时两组HR明显减慢,SBP和DBP明显降低(P0.05)。与T1、T2时比较,T3~T6时两组CK-MB、cTnT、E浓度明显升高(P0.05),T3~T5时A组NE浓度明显下降(P0.05),T6时明显升高(P0.05)。T3~T6时A组CK-MB和cTnT浓度明显低于C组(P0.05)。T3~T5时A组E和NE浓度明显低于C组(P0.05)。两组在围术期均未出现严重不良反应。结论右美托咪定能降低全麻低温CPB下冠状动脉旁路移植术围术期心肌缺血的发生,达到围术期心肌保护的作用。
[Abstract]:Objective to observe the myocardial protective effect of dexmetomidine on patients undergoing coronary artery bypass grafting (CABG) under hypothermia cardiopulmonary bypass (CPB) under general anesthesia. Methods 80 patients (67 males and 13 females) underwent elective coronary artery bypass grafting (CABG) under hypothermic CPB under general anesthesia. All patients were randomly divided into dexmetomidine group (group A) and control group (group C). Right metoimidine 4 渭 g kg-1 h-1 was injected intravenously into group A after central venous catheterization. The adjustment and maintenance dose was 0.7 渭 g kg-1 h-1 until the end of operation. Group C received the same dose of saline intravenously. HRSBP DBP and the dosage of vasoactive drugs were recorded at the end of operation, including T _ 0, T _ 1, T _ (2) and T _ (3) after anesthesia induction, and T _ (4) at the end of operation. The plasma levels of creatine kinase isoenzyme (CK-MBN), cardiac troponin (TnTnTU), epinephrine (E) and norepinephrine (NE) were measured in T _ (1) T _ (4), 6 h postoperatively and 24 h (n = 24 h) T _ (6) plasma creatine kinase isoenzyme (CK-MBN). Results compared with T _ 0, HR of T _ 1 and T _ 1 groups were significantly decreased, SBP and DBP were significantly decreased (P _ (0.05). Compared with T _ 1 T _ 2, the concentrations of CK-MB and cTnT in group A were significantly lower than those in group A at P 0.05, T _ 3, T _ 6, P _ (0.05) and T _ (3) T _ (6), and the concentrations of CK-MB and cTnT in group A were significantly lower than those in group A (P 0.05) at T _ (5) and T _ (3) T _ (5) (P _ (0.05) and the concentrations of NE and NE in group A were significantly lower than those in group C (P < 0.05) at T _ (6) and T _ (3) T _ (6), compared with T _ (1) T _ (2) and T _ (3) T _ (6). There were no serious adverse reactions in both groups during perioperative period. Conclusion dexmetomidine can reduce the incidence of perioperative myocardial ischemia after coronary artery bypass grafting (CABG) under hypothermia CPB and achieve perioperative myocardial protection.
【作者单位】：中国医学科学院北京协和医学院国家心血管病中心心血管疾病国家重点实验室阜外心血管病医院麻醉科;
【基金】：院所青年基金(2013-F08)
【分类号】：R614

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