右美托咪定靶控输注在冠状动脉搭桥术中的作用
|
摘要
目的研究右美托咪定靶控输注在冠状动脉搭桥术(CABG)中的作用。方法纳入2015年1月～2017年10月于我院行CABG治疗的94例冠心病患者,数字法随机分为观察组与对照组,每组各47例。两组均采用常规气管插管全麻,观察组在此基础上进行右美托咪定靶控输注,对照组输注等量生理盐水。将麻醉诱导前、麻醉后、插管前、插管后及插管后5min设为T0、T1、T2、T3、T4,比较各时间点两组动脉舒张压(DBP)、收缩压(SBP)、平均动脉压(MAP)、心率(HR)、HR与SBP乘积(RPP)以及手术时间、拔管时间、苏醒时间。结果两组T0、T1、T2 HR、RPP比较差异均无统计学意义(P>0.05),T3、T4观察组HR低于对照组,差异具有统计学意义(P<0.05);两组T0、T1、T2DBP、SBP、MAP比较差异均无统计学意义(P>0.05),T3、T4观察组DBP、SBP、MAP均低于对照组,差异具有统计学意义(P<0.05);两组手术时间比较差异无统计学意义(P>0.05);观察组苏醒时间、拔管时间低于对照组,差异具有统计学意义(P<0.05)。结论冠心病冠状动脉搭桥术治疗运用右美托咪定靶控输注能够降低插管后血压与心率,即减轻气管插管时心血管反应及心肌耗氧。
Objective To investigate the effects of target-controlled infusion of dexmedetomidine on coronary artery bypass grafting. Methods In this study, 94 patients with coronary heart disease undergoing CABG in our hospital from January 2015 to October 2017 were selected and randomly divided into observation group and control group, each group 47 cases. All patients received conventional tracheal intubation general anesthesia. Based on this, the observation cases received the target-controlled infusion of dexmedetomidine. The control group cases were infused with the same amount of saline. The levels of diastolic blood pressure(DBP), systolic blood pressure(SBP), MAP, HR and RPP were recorded before induction(T_0), after drug injection(T_1), before intubation(T_2) and 5 min after intubation(T_3), then the operation time, extubation time and awakening time were also recorded. Results The HR and RPP of the two groups at the T_0, T_1,T_2 had no significant difference(P>0.05). The HR at the T_(3 )and T_4 in the observation group were significantly lower than those in the control group(P<0.05). The DBP, SBP and MAP of the two groups at the T_0, T_1,T_2 had no significant difference(P>0.05). The DBP, SBP and MAP at the T_(3 )and T_4 in the observation group were significantly lower than those in the control group(P<0.05). The operation time of the two groups had no significant difference(P>0.05). The extubation time and awakening time of the observation group were significantly shorter than those in the control group(P<0.05). Conclusion The application of target-controlled infusion of dexmedetomidine on coronary artery bypass grafting in coronary heart disease can reduce the blood pressure and heart rate after intubation, which means that cardiovascular response and myocardial oxygen consumption will be reduced during the intubation.
Objective To investigate the effects of target-controlled infusion of dexmedetomidine on coronary artery bypass grafting. Methods In this study, 94 patients with coronary heart disease undergoing CABG in our hospital from January 2015 to October 2017 were selected and randomly divided into observation group and control group, each group 47 cases. All patients received conventional tracheal intubation general anesthesia. Based on this, the observation cases received the target-controlled infusion of dexmedetomidine. The control group cases were infused with the same amount of saline. The levels of diastolic blood pressure(DBP), systolic blood pressure(SBP), MAP, HR and RPP were recorded before induction(T_0), after drug injection(T_1), before intubation(T_2) and 5 min after intubation(T_3), then the operation time, extubation time and awakening time were also recorded. Results The HR and RPP of the two groups at the T_0, T_1,T_2 had no significant difference(P>0.05). The HR at the T_(3 )and T_4 in the observation group were significantly lower than those in the control group(P<0.05). The DBP, SBP and MAP of the two groups at the T_0, T_1,T_2 had no significant difference(P>0.05). The DBP, SBP and MAP at the T_(3 )and T_4 in the observation group were significantly lower than those in the control group(P<0.05). The operation time of the two groups had no significant difference(P>0.05). The extubation time and awakening time of the observation group were significantly shorter than those in the control group(P<0.05). Conclusion The application of target-controlled infusion of dexmedetomidine on coronary artery bypass grafting in coronary heart disease can reduce the blood pressure and heart rate after intubation, which means that cardiovascular response and myocardial oxygen consumption will be reduced during the intubation.
引文
[1] 陈晓霞, 楼季庄, 管延蒙,等. 1427例冠状动脉疾病患者慢性肾脏病的流行病学调查[J]. 中国中西医结合肾病杂志, 2013, 14(6):517-519.
[2] 韩红亚, 周玉杰, 史宏志,等. 男性早发冠状动脉粥样硬化性心脏病患者临床及冠状动脉特点分析[J]. 中国医药, 2015, 10(7):929-933.
[3] 郑奇斌, 陈克俭, 徐翔,等. 老年冠心病合并糖尿病患者临床特点及冠状动脉病变特征分析[J]. 中国心血管病研究, 2015, 13(12):1074-1077.
[4] 杜守峰, 师文华, 孙君隽,等. 冠心病冠状动脉搭桥术联合右美托咪定靶控输注对冠心病疗效及HR、MAP、RPP的影响[J]. 中西医结合心脑血管病杂志, 2017, 15(18):2290-2293.
[5] Karaman Y, Abud B, Tekgul ZT, et al. Effects of dexmedetomidine and propofol on sedation in patients after coronary artery bypass graft surgery in a fast-track recovery room setting[J]. Journal of Anesthesia, 2015, 29(4):522-528.
[6] 郭正轩, 康红灿, 胡张钊. 右美托咪定对行非体外循环冠脉搭桥术后老年患者认知功能的影响[J]. 中国临床医生杂志, 2017, 45(8):86-89.
[7] Lee TW, Kowalski S, Falk K, et al. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study[J]. Plos One, 2016, 11(3):e0149942.
[8] 罗敏, 侯崧, 雷宇,等. 右美托咪定减少冠脉搭桥术后新发房颤的临床研究[J]. 中西医结合心脑血管病杂志, 2016, 14(19):2300-2302.
[9] 朱琰, 艾艳秋, 王欢乐,等. Narcotrend监测下右美托咪定对冠心病患者麻醉诱导期血流动力学的影响[J]. 医学与哲学, 2014, 35(4):35-38.
[10] Hamarneh A, Sivaraman V, Bulluck H, et al. The Effect of Remote Ischemic Conditioning and Glyceryl Trinitrate on Perioperative Myocardial Injury in Cardiac Bypass Surgery Patients: Rationale and Design of the ERIC-GTN Study[J]. Clinical Cardiology, 2015, 38(11):641.
[11] 韩红亚, 周玉杰, 史宏志,等. 早发女性冠心病患者临床及冠状动脉病变特点分析[J]. 心肺血管病杂志, 2015, 34(5):356-359.
[12] 李明良, 邓军, 左朝晖,等. 预注右美托咪定复合靶控输注丙泊酚-瑞芬太尼对静脉全身麻醉效果的影响[J]. 现代中西医结合杂志, 2016, 25(17):1912-1913.
[13] Shoulders BR, Crow JR, Davis SL, et al. Impact of Intraoperative Continuous-Infusion Versus Intermittent Dosing of Cefazolin Therapy on the Incidence of Surgical Site Infections After Coronary Artery Bypass Grafting.[J]. Pharmacotherapy, 2016, 36(2):166.
[14] 孙艳萍, 张召义. 不同剂量右美托咪定联合丙泊酚应用于宫腔镜手术比较[J]. 现代仪器与医疗, 2016, 22(5):56-58.
[15] 张继如, 陈敏, 王志强,等. 右美托咪定和七氟醚改善冠心病非心脏手术患者围术期心肌缺血的比较[J]. 临床麻醉学杂志, 2017, 33(3):273-276.
[16] 甘国胜, 周翔, 秦明哲,等. 右美托咪定预先给药对高血压冠心病患者诱导插管时血流动力学及应激反应的影响[J]. 现代生物医学进展, 2015, 15(29):5685-5687.
[17] 任玲. 右美托咪定对老年冠心病患者围术期心脏自主神经系统功能的影响[J]. 现代中西医结合杂志, 2016, 25(18):1964-1966.
[18] 姜莎莎, 金延武. 右美托咪定在冠心病患者俯卧位腰椎手术全麻中的应用[J]. 山东医药, 2017, 57(42):67-70.
[19] 伍佳莉, 苏松, 王晓斌,等. 右美托咪定对全麻后老年患者早期认知功能的影响[J]. 西部医学, 2015, 27(3):415-417.
[20] 鲁舜蓉, 衡孝伶, 李显碧,等. 右美托咪定对老年胃肠肿瘤根治术患者围术期细胞免疫功能的影响[J]. 西部医学, 2016, 28(7):972-975.
[21] Li R, Lan B, Zhu T, et al. Preventing graft restenosis after coronary artery bypass grafting with tissue-type plasminogen activator:[J]. European Journal of Medical Research, 2017, 22(1):18.
[2] 韩红亚, 周玉杰, 史宏志,等. 男性早发冠状动脉粥样硬化性心脏病患者临床及冠状动脉特点分析[J]. 中国医药, 2015, 10(7):929-933.
[3] 郑奇斌, 陈克俭, 徐翔,等. 老年冠心病合并糖尿病患者临床特点及冠状动脉病变特征分析[J]. 中国心血管病研究, 2015, 13(12):1074-1077.
[4] 杜守峰, 师文华, 孙君隽,等. 冠心病冠状动脉搭桥术联合右美托咪定靶控输注对冠心病疗效及HR、MAP、RPP的影响[J]. 中西医结合心脑血管病杂志, 2017, 15(18):2290-2293.
[5] Karaman Y, Abud B, Tekgul ZT, et al. Effects of dexmedetomidine and propofol on sedation in patients after coronary artery bypass graft surgery in a fast-track recovery room setting[J]. Journal of Anesthesia, 2015, 29(4):522-528.
[6] 郭正轩, 康红灿, 胡张钊. 右美托咪定对行非体外循环冠脉搭桥术后老年患者认知功能的影响[J]. 中国临床医生杂志, 2017, 45(8):86-89.
[7] Lee TW, Kowalski S, Falk K, et al. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study[J]. Plos One, 2016, 11(3):e0149942.
[8] 罗敏, 侯崧, 雷宇,等. 右美托咪定减少冠脉搭桥术后新发房颤的临床研究[J]. 中西医结合心脑血管病杂志, 2016, 14(19):2300-2302.
[9] 朱琰, 艾艳秋, 王欢乐,等. Narcotrend监测下右美托咪定对冠心病患者麻醉诱导期血流动力学的影响[J]. 医学与哲学, 2014, 35(4):35-38.
[10] Hamarneh A, Sivaraman V, Bulluck H, et al. The Effect of Remote Ischemic Conditioning and Glyceryl Trinitrate on Perioperative Myocardial Injury in Cardiac Bypass Surgery Patients: Rationale and Design of the ERIC-GTN Study[J]. Clinical Cardiology, 2015, 38(11):641.
[11] 韩红亚, 周玉杰, 史宏志,等. 早发女性冠心病患者临床及冠状动脉病变特点分析[J]. 心肺血管病杂志, 2015, 34(5):356-359.
[12] 李明良, 邓军, 左朝晖,等. 预注右美托咪定复合靶控输注丙泊酚-瑞芬太尼对静脉全身麻醉效果的影响[J]. 现代中西医结合杂志, 2016, 25(17):1912-1913.
[13] Shoulders BR, Crow JR, Davis SL, et al. Impact of Intraoperative Continuous-Infusion Versus Intermittent Dosing of Cefazolin Therapy on the Incidence of Surgical Site Infections After Coronary Artery Bypass Grafting.[J]. Pharmacotherapy, 2016, 36(2):166.
[14] 孙艳萍, 张召义. 不同剂量右美托咪定联合丙泊酚应用于宫腔镜手术比较[J]. 现代仪器与医疗, 2016, 22(5):56-58.
[15] 张继如, 陈敏, 王志强,等. 右美托咪定和七氟醚改善冠心病非心脏手术患者围术期心肌缺血的比较[J]. 临床麻醉学杂志, 2017, 33(3):273-276.
[16] 甘国胜, 周翔, 秦明哲,等. 右美托咪定预先给药对高血压冠心病患者诱导插管时血流动力学及应激反应的影响[J]. 现代生物医学进展, 2015, 15(29):5685-5687.
[17] 任玲. 右美托咪定对老年冠心病患者围术期心脏自主神经系统功能的影响[J]. 现代中西医结合杂志, 2016, 25(18):1964-1966.
[18] 姜莎莎, 金延武. 右美托咪定在冠心病患者俯卧位腰椎手术全麻中的应用[J]. 山东医药, 2017, 57(42):67-70.
[19] 伍佳莉, 苏松, 王晓斌,等. 右美托咪定对全麻后老年患者早期认知功能的影响[J]. 西部医学, 2015, 27(3):415-417.
[20] 鲁舜蓉, 衡孝伶, 李显碧,等. 右美托咪定对老年胃肠肿瘤根治术患者围术期细胞免疫功能的影响[J]. 西部医学, 2016, 28(7):972-975.
[21] Li R, Lan B, Zhu T, et al. Preventing graft restenosis after coronary artery bypass grafting with tissue-type plasminogen activator:[J]. European Journal of Medical Research, 2017, 22(1):18.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |