【摘要】 目的比较不同剂量右美托咪定对冠状动脉搭桥术患者麻醉诱导期间血流动力学的影响。方法选择拟行非心肺转流冠状动脉搭桥术患者75例,男54例,女21例,年龄45⁷0岁,体重55⁸0kg,BMI 18.5～24.5kg/m²,ASAⅡ或Ⅲ级,左室射血分数≥45%,NYHA心功能分级Ⅱ或Ⅲ级。采用随机数字表法将患者随机分为三组:右美托咪定0.3μg/kg组（D3组）、右美托咪定0.6μg/kg组（D6组）和右美托咪定0.9μg/kg组（D9组）。D3组、D6组和D9组分别于麻醉诱导前10min静脉输注右美托咪定0.3、0.6、0.9μg/kg,输注时间10min。麻醉诱导后,BIS≤55时行气管插管后机械通气。记录右美托咪定输注前（T₀）、输注5min（T₁）、输注完毕（T₂）、气管插前即刻（T₃）、气管插管后1min（T₄）、气管插管后3min（T₅）、气管插管后5min（T₆）时的HR、SBP、DBP;记录麻醉诱导期间的低血压、高血压、心动过缓和呼吸抑制等不良事件发生情况。结果与T₀时比较,T₁—T₆时D6组和D9组HR明显减慢（P <0.05）,T₁时D9组SBP、DBP明显升高,T₃时三组SBP、DBP明显降低（P <0.05）,T₄时D3组HR明显增快（P <0.05）。与T₃时比较,T₄和T₅时D3组HR明显增快,SBP、DBP明显升高（P <0.05）。与D3组比较,D6组和D9组T₃时SBP、DBP明显升高（P <0.05）,T₄时HR明显减慢（P <0.05）。与D3组比较,D6组和D9组发生低血压明显减少,D9组发生高血压,心动过缓和呼吸抑制明显增多（P <0.05）。与D6组比较,D9组发生高血压、心动过缓和呼吸抑制明显增多（P <0.05）。结论与右美托咪定0.3和0.9μg/kg的负荷量比较,麻醉诱导前10min静脉输注0.6μg/kg右美托咪定更有助于稳定冠状动脉搭桥术患者麻醉诱导期间的血流动力学,有利于维持心肌氧供需平衡。更多还原

【Abstract】 Objective To evaluate the effects of different doses of dexmedetomidine on hemodynamics during anesthesia induction in patients undergoing coronary artery bypass grafting.Methods Seventy-five patients 54 males and 21 females,aged 45-70 years,weighing 55-80 kg,BMI 18.5-24.5 kg/m2,ASA physical statusⅡ orⅢ,NYHA Ⅱ orⅢand left ventricular ejection fraction≥ 45%,undergoing off-pump coronary artery bypass grafting,were randomly divided into groups D3,D6 and D9 using a random number table.Dexmedetomidine 0.3,0.6 and 0.9μg/kg were infused intravenously for 10 min before induction of anesthesia in groups D3,D6 and D9,respectively.After induction of anesthesia,the patients were tracheally intubated and mechanically ventilated when BIS value≤55.HR,SBP and DBP were recorded before dexmedetomidine infusion （T₀）,5 and10 min after dexmedetomidine infusion （T₁-T₂）,immediately before intubation （T₃）and 1,3,5 min after intubation （T₄-T₆）.The incidences of adverse cardiovascular events （hypotension,hypertension and bradycardia）and respiratory depression were also recorded during anesthesia induction.ResultsCompared with T₀,HR was significantly decreased at T₁-T₆ in groups D6 and D9 （P <0.05）,SBP and DBP were significantly increased at T₁ in group D9 （P <0.05）,while decreased at T₃ in all three groups （P < 0.05）,and HR was increased at T₄ in group D3 （P <0.05）.Compared with T₃,the HR,SBP and DBP were significantly increased at T₄ and T₅ in group D3 （P < 0.05）.Compared with group D3,SBP and DBP of groups D6 and D9 were significantly increased at T₃ （P < 0.05）,while HR was decreased at T₄ （P < 0.05）.T_he rate of hypotension was significantly lower in groups D6 and D9 than that in group D3 （P < 0.05）.Besides,the incidence of hypertension,bradycardia and respiratory depression were significantly increased in group D9 than those in groups D3 and D6 （P < 0.05）.Conclusion Compared with 0.3 and 0.9μg/kg,dexmedetomidine 0.6μg/kg intravenous infusion is better to keep the stability of hemodynamics and the balance of myocardial oxygen delivery and consumption during anesthesia induction in patients undergoing coronary artery bypass grafting.更多还原