右美托咪定预充对心脏手术患者体外循环期间血流动力学的影响

发布时间：2018-02-02 20:05

本文关键词： 右美托咪定预充液体外循环血流动力学平均动脉压　出处：《中国药房》2017年02期 　论文类型：期刊论文

【摘要】：目的:评价右美托咪定预充对心脏手术患者体外循环(CPB)期间血流动力学的影响。方法:将择期行二尖瓣和主动脉瓣置换术的风湿性心脏病患者80例,按随机数字表法分为对照组(C组)和右美托咪定组(D组),各40例。全麻下D组患者预充液中加入右美托咪定1μg/kg,C组患者预充液中加入等量氯化钠溶液。观察两组患者CPB前并行阶段的平均动脉压(MAP)和心率(HR);观察两组患者CPB期间升压药(间羟胺)和降压药(酚妥拉明)的使用量、降压药使用前后的MAP变化和两次用药间隔时间;记录两组患者CPB期间的麻醉药物使用量;于麻醉诱导前5 min(t_1)、CPB前5 min(t_2)、CPB 30 min(t_3)、CPB 60 min(t_4)、CPB结束(t_5)、术后2 h(t_6)、术后12 h(t_7)和术后24 h(t_8)测定两组患者的血清白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平;观察两组患者心脏复跳时间、复跳例数及心律失常(室颤)发生情况,前/后并行循环时间和主动脉阻断时间,心脏复跳后各时段的多巴胺使用量及心动过缓的发生情况。结果:与C组比较,D组患者CPB前并行阶段的MAP明显升高、HR明显降低,间羟胺和酚妥拉明的使用量明显减少,两次用药间隔时间明显延长,CPB期间的咪达唑仑和丙泊酚用量明显减少,差异均有统计学意义(P0.05)。CPB转流后两组患者血清IL-6和TNF-α水平随时间逐渐升高,至CPB结束时(t5)达到最高;与t_1比较,两组患者在t_3~t_8时点的血清IL-6和t_2~t_8时点的血清TNF-α水平均明显升高;与C组比较,D组患者在t_4~t_7时点的血清IL-6和t_3~t_7时点的血清TNF-α水平均明显降低,差异均有统计学意义(P0.05)。两组患者心脏复跳时间、复跳例数、复跳后室颤例数、前/后并行循环时间和主动脉阻断时间比较,差异均无统计学意义(P0.05)。两组患者心脏复跳后多巴胺的使用量随时间逐渐减少,但各时段组间比较差异均无统计学意义(P0.05)。复跳后两组患者均未见心动过缓现象发生。结论:右美托咪定1μg/kg加入到预充液中可有效预防心脏手术患者CPB开始时的一过性低血压,同时可减轻其CPB期间血压的升高现象。
[Abstract]:Objective: to evaluate the effect of dexmetomidine preimplantation on hemodynamics during cardiopulmonary bypass (CPB) in patients undergoing cardiac surgery. Methods: 80 patients with rheumatic heart disease underwent mitral and aortic valve replacement. According to the random number table method, the patients in group D were divided into control group (group C) and dexmetomidine group (group D, n = 40). Under general anesthesia, dexmetomidine 1 渭 g / kg was added to the prefilled solution of group D patients. In group C, sodium chloride solution was added to the prefilled fluid. The mean arterial pressure (map) and heart rate (HRV) were observed in the two groups before and after CPB. The dosage of hypotensive drugs (m-hydroxylamine) and hypotensive drugs (phentol Lemine), the changes of MAP before and after the use of antihypertensive drugs and the time interval between the two groups during CPB were observed. The use of narcotic drugs during CPB was recorded in both groups. 5 min before induction of anesthesia, 5 min before CPB, 5 min before CPB, 30 min / 30 min / t / t / t / t / t _ 2 / t _ 2 / t _ 2 / 60 min / t _ 4). CPB ended with T _ 5s, and 2 h after operation, there was no significant difference between the two groups (t _ (6)). Serum levels of interleukin-6 (IL-6) and tumor necrosis factor- 伪 (TNF- 伪) were measured at 12 h postoperatively and 24 h after operation. The time of cardiac resuscitation, the number of cases, the incidence of arrhythmia (ventricular fibrillation), the time of anterior / posterior circulation and the time of aortic occlusion were observed. Results: compared with group C, the level of MAP in group D was significantly higher than that in group C (P < 0.05). The use of m-hydroxylamine and phentol Lemine decreased significantly, and the dosage of midazolam and propofol decreased significantly during CPB. There were significant differences in serum IL-6 and TNF- 伪 levels between the two groups after P0.05. CPB bypass, and reached the highest level at the end of CPB. Compared with t1, the levels of serum IL-6 and TNF- 伪 in the two groups were significantly higher than those in the two groups at t _ 3 / t _ 8 and t _ 2 / t _ 8 respectively. Compared with group C, the levels of serum IL-6 and TNF- 伪 of patients in group D were significantly lower than those in group C at the time of T _ 4 / T _ 7 and T _ 3 / T _ 7 respectively. There were significant differences between the two groups (P 0.05). The time of cardiac resuscitation, the number of cases of complex beat, the number of cases of ventricular fibrillation after resuscitation, the time of anterior / posterior parallel circulation and the time of aortic occlusion were compared between the two groups. There was no significant difference between the two groups (P 0.05). The amount of dopamine in the two groups decreased gradually with time after cardiac resuscitation. But there was no significant difference between different groups (P0.05). There was no bradycardia in both groups after resuscitation. Conclusion: adding dexmetomidine 1 渭 g / kg into the prefilled solution can effectively prevent transient hypotension at the beginning of CPB in patients undergoing cardiac surgery. At the same time, it can reduce the increase of blood pressure during CPB.
【作者单位】：川北医学院附属医院麻醉科;
【基金】：四川省卫生厅科研课题(No.120444)
【分类号】：R614
【正文快照】： 本研究结果表明,超说明书用药组患者的治疗有效率、细菌清除率和脱机成功率均明显高于常规用药组,28 d死亡率明显低于常规用药组,ICU住院时间和总住院时间明显短于常规用药组,差异均有统计学意义(P0.05)。超说明书用药组的不良反应发生率与常规用药组相当,组间比较差异无统计

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