右美托咪定用于体外循环心脏手术的临床观察

    Clinical application of dexmedetomidine in cardiopulmonary bypass surgery

    • 摘要: 目的:观察右美托咪定(Dex)用于体外循环(cardiopulmonary bypass,CPB)心脏手术的疗效和安全性。方法:选择需行择期CPB心脏手术120例心脏病病人,随机分为2组,各60例。对照组(C组):常规麻醉诱导,咪达唑仑0.05 mg/kg、舒芬太尼0.2~0.3 μg/kg,丙泊酚1~2 mg/kg,顺式阿曲库铵0.2 mg/kg,气管插管后舒芬太尼以0.1 μg·kg-1·h-1速率持续泵注,直至CPB结束。观察组(D组):预先泵注Dex 1 μg/kg,10 min,Dex泵注5 min时按C组常规麻醉诱导插管,之后以0.5 μg·kg-1·h-1持续泵注直至CPB结束。记录病人术中各时点心率、平均动脉压变化情况;采集静脉血检测血清皮质醇(COR)和醛固酮(ALD)水平;记录术中Dex相关的不良反应发生情况(低血压、高血压、心动过缓、心跳骤停等);记录术后2周内不良反应发生率(肺部感染、认知功能改变、中风瘫痪及死亡等)。结果:与C组相比,D组病人术中各时点心率、平均动脉压均较低(P <0.05~P <0.01);血清COR和ALD水平也显著低于C组(P<0.01)。2组病人术后2周内不良反应发生率差异无统计学意义(P>0.05)。结论:Dex用于CPB心脏手术能够一定程度减轻病人围手术期血流动力学波动,降低血清COR和ALD水平,利于提高病人围手术期康复质量,具有临床推广价值。

       

      Abstract: Objective:To observe the efficacy and safety of dexmedetomidine(Dex) in cardiopulmonary bypass(CPB) surgery.Methods:One hundred and twenty heart disease patients scheduled by CPB surgery were randomly divided into the control group(group C) and observation group(group D)(60 cases each group).The control group was generally anesthetized induction with 0.05 mg/kg of midazolam,0.2 to 0.3 μg/kg of sufentanil,1 to 2 mg/kg of propofol and 0.2 mg/kg of cisatracurium,and sufentanyl was continuously infused at the rate of 0.1 μg·kg-1·h-1 until the end of CPB after endotracheal intubation.The 1 μg/kg of Dex in group D was infused for 10 min before anesthesia,The group D was intubated under general anesthesia induction as the group C after 5 min of infusion of Dex,and then continuously infused with Dex at the rate of 0.5 μg·kg-1·h-1 until the end of CPB.The heart rate and average arterial pressure in two groups were recorded at each time-point.The levels of venous serum cortisol(COR) and aldosterone(ALD) in two groups were compared.The Dex-related adverse reactions(hypotension,hypertension,bradycardia and cardiac arrest) and incidence rates of adverse reactions(lung infection,cognitive function,stroke,paralysis and death) within 2 weeks after operation were recorded.Results:Compared with group C,the heart rate and average arterial pressure at each time-point in group D were lower(P <0.05 to P <0.01).The levels of COR and ALD in group D were lower than those in group C(P<0.01).The difference of the incidence rate of adverse reaction within 2 weeks after operation between two groups was not statistically significant(P>0.05).Conclusions:The application of Dex in CPB surgery can alleviate the hemodynamic fluctuation during operation,decrease the serum COR and ALD levels,reduce stress reactions and improve the perioperative quality of rehabilitation of patients to some extent,which is worthy of promotion.

       

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