地氟烷复合右美托咪定对不停跳冠状动脉搭桥术（OPCABG）患者的疗效分析

doi:10.12092/j.issn.1009-2501.2018.04.013

摘要/Abstract

摘要：

目的:探讨地氟烷复合右美托咪定对不停跳冠状动脉搭桥术(OPCABG)患者应激反应、炎性反应及心肌的影响。方法:将68例择期行OPCABG患者按照随机数字表法，分为观察组和对照组，各34例。两组均采用咪达唑仑0.1～0.2 mg/kg、依托咪酯0.15～0.3 mg/kg、舒芬太尼2 μg/kg、维库溴铵0.1 mg/kg静脉注射进行麻醉诱导。观察组术中静脉输注右美托咪定0.1～0.3 μg·kg-1·h-1，同时给予0.7～1.5肺泡气最低有效浓度（MAC）的地氟烷维持麻醉，对照组给予静脉输注右美托咪定0.5 μg·kg-1·h-1维持麻醉。比较两组心脏指数(CI)、心率(HR)、血压(ABP)、中心静脉压(CVP)、肺动脉压(PAP)及肺动脉楔压(PAWP)、血浆肌钙蛋白Ⅰ(cTnI)及肌酸激酶同工酶(CK-MB)水平、血清皮质醇(COR)、β-内啡肽(β-EP)、C-反应蛋白(CRP)、IL-2、IL-6浓度、不良反应和吗啡使用情况。结果:观察组CI在搭桥后0.5 h、术毕及术毕1 h时均显著高于麻醉诱导后0.5 h，同时搭桥后0.5 h时显著高于对照组，对照组在术毕1 h时显著高于麻醉诱导后0.5 h时；观察组HR在麻醉诱导后0.5 h时明显低于对照组，在其他时间点均明显高于麻醉诱导后0.5 h（P均＜0.05）。其他指标差异均无统计学意义（P均＞0.05）。术后6、12、24 h时，两组cTnⅠ及CK-MB水平均持续上升，到术后24 h时达到峰值，术后36 h时有所下降，但均高于术前，且术后12 h时观察组cTnⅠ及CK-MB水平均明显低于对照组（P均＜0.05）。COR方面，两组T1-4时段均显著低于T0，且观察组T2-4时段显著低于对照组；β-EP、CRP方面，两组T1-4时段均显著高于T0，观察组显著低于对照组；IL-2方面，观察组T1-4时段均显著高于对照组；IL-6方面，两组T1-4时段均显著低于T0，观察组T3时显著高于对照组（P均＜0.05）。两组均未发生呼吸抑制、心动过缓或低血压等不良反应。对照组吗啡使用率显著高于观察组（χ2=4.570，P＜0.05）。结论:地氟烷复合右美托咪定可以安全有效地用于OPCABG麻醉过程中，可有效减轻患者手术的应激反应和炎性反应，减少心肌损伤，稳定血流动力学状态，值得推广。

关键词: 右美托咪定, 地氟烷, 血流动力学, 不停跳冠状动脉搭桥术

Abstract:

AIM: To investigate the effects of desflurane combined with dexmedetomidine on stress response, inflammatory response and myocardium in patients undergoing coronary artery bypass grafting (OPCABG). METHODS: Sixty-eight patients undergoing OPCABG were randomly divided into observation group and control group according to the random number table method, with 34 cases in each group. Both groups were given midazolam 0.1-0.2 mg/kg, etomidate 0.15-0.3 mg/kg, sufentanil 2 μg/kg and vecuronium 0.1 mg/kg intravenous anesthesia induction. The observation group received intravenous dexmedetomidine 0.1-0.3 μg·kg^-1·h^-1 and desflurane with the lowest effective concentration (MAC) of 0.7-1.5, while the control group was given intravenous dexmedetomidine 0.5 μg·kg^-1·h^-1 to maintain anesthesia. The changes of cardiac index (CI), heart rate (HR), blood pressure (ABP), central venous pressure (CVP), pulmonary arterial pressure (PAP) and pulmonary arterial pressure (PAWP), plasma cTnI and the levels of creatine kinase isoenzyme（CK-MB）, COR, β-EP, CRP, IL-2 and interleukin 6 (IL-6) concentrations, adverse reactions and morphine use were compared between two groups. RESULTS: The CI of observation group at 0.5 h and1 h after bypass were significantly higher than that at 0.5 h after anesthesia; also, CI of observation group at 0.5 h was significantly higher than that of the control group; CI of control group at 1 h was significantly higher than that at 0.5 after anesthesia.HR in the observation group was significantly lower than that of the control group at 0.5 h after induction and HR was significantly higher at other time points than that at 0.5 h after anesthesia (P＜0.05). No significant difference was observed between other indicators (P＞0.05). Levels of cTn I and CK-MB in both groups continued to increase at 6, 12 and 24 h after operation, peaked at 24 h and decreased at 36 h after operation, both indicators were higher than those before operation; levels of cTnI and CK-MB at 12 h after operation in the observation group were significantly lower than those in the control group (P＜0.05).COR during the T1-4 period were significantly lower than that during T0 in the both groups; COR of the observation group during T2-4 period was significantly lower than that of the control group. β-EP and CRP during the T1-4 period were significantly lower than that during T0 in the both groups; β-EP and CRP of the observation group during T2-4 period was significantly lower than that of the control group. Levels of IL-2 in observation group were significantly higher than those in control group. Levels IL-6 during T1-4 in both groups were significantly lower than those during T0 period, and those of the observation group at T3 was significantly higher than that in control group (P＜0.05). No adverse reactions such as respiratory depression, bradycardia or hypotension occurred in both groups. Morphine usage in the control group was significantly higher than that in the observation group (χ²=4.570, P＜0.05). CONCLUSION: Desflurane combined with dexmedetomidine can be safely and effectively used in the OPCABG anesthesia process. It can effectively reduce the stress response and inflammatory reaction, reduce the myocardial injury and stabilize the hemodynamic status of patients, which is worthy of promotion.

Key words: dexmedetomidine, desflurane, hemodynamics, coronary artery bypass grafting

中图分类号:

R749

刘莹，邵军进，孙大新. 地氟烷复合右美托咪定对不停跳冠状动脉搭桥术（OPCABG）患者的疗效分析[J]. 中国临床药理学与治疗学, 2018, 23(4): 440-445.

LIU Ying, SHAO Junjin, SUN Daxin. Effects of desflurane combined with dexmedetomidine in patients undergoing coronary artery bypass grafting [J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2018, 23(4): 440-445.

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