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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
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| 篇名： | 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 |
| TITLE： | |
| 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1 μg/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（t1）、CPB前5 min（t2）、CPB 30 min（t3）、CPB 60 min（t4）、CPB结束（t5）、术后2 h（t6）、术后12 h（t7）和术后24 h（t8）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（P＜0.05）。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t1比较，两组患者在t3～t8时点的血清IL-6和t2～t8时点的血清TNF-α水平均明显升高；与C组比较，D组患者在t4～t7时点的血清IL-6和t3～t7时点的血清TNF-α水平均明显降低，差异均有统计学意义（P＜0.05）。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（P＞0.05）。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（P＞0.05）。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1 μg/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 effects of dexmedetomidine priming solution on the hemodynamics of heart surgery patients during cardiopulmonary bypass （CPB）. METHODS： 80 patients with rheumatic heart disease （RHD） undergoing selective aortic and mitral valve replacement were divided into control group （group C） and dexmedetomidine group （group D）， with 40 cases in each group. The dexmedetomidine 1 μg/kg was added to the priming solution of the extracorporeal circulation in group D， and an equivalent volume prime without dexmedetomidine was received in group C. MAP and HR of 2 groups were observed at pre-parallel stage of CPB. The amount of vasopressor drugs （metaradrine） and antihypertensive drugs （phentolamine） during CPB， the change of MAP and medication interval before and after the use of antihypertensive drugs were observed in 2 groups. The amount of narcotic drugs were recorded in 2 groups during CPB. The levels of serum IL-6 and TNF-α in 2 groups were determined 5 min before anesthesia induction （t1）， 5 min before CPB （t2）， 30 （t3）， 60 min （t4） during CPB， after CPB （t5）， 2 （t6）， 12（t7）， 24 h （t8） after surgery. The time and case number of cardiac resuscitation， the occurrence of arrhythmia were observed in 2 groups. Pre- and post-parallel cycle time and aortic cross-clamp time were observed in 2 groups. The amount of dopamine were observed in 2 groups at different stages after cardiac resuscitation. The occurrence of bradycardia was observed in 2 groups after cardiac resuscitation. RESULTS： Compared to group C， the MAP was increased in group D at pre-parallel stage of CPB， while HR and the amount of metaradrine and phentolamine were decreased significantly； medication interval was prolonged significantly， and the amount of midazolam and propofol were decreased significantly， with statistical significance （P＜0.05）. Serum levels of IL-6 and TNF-α in 2 groups were increased gradually as time after CPB， and reached the maximal value at the end of CPB （t5）. Compared with t1， serum levels of IL-6 at t3-t8 and serum levels of TNF-α at t2-t8 were increased significantly in 2 groups. Compared with group C， serum levels of IL-6 at t4-t7 and serum levels of TNF-α at t3-t7 were decreased significantly in 2 groups， with statistical significance （P＜0.05）. There was no statistical significance in the time and case number of cardiac resuscitation， case number of ventricular fibrillation after resuscitation， pre- and post-parallel cycle time and aortic cross-clamp time between 2 groups （P＞0.05）. The amount of dopamine in 2 groups decreased gradually as time after resuscitation， but there was no statistical significance among different stages between 2 groups （P＞0.05）. No bradycardia was found in 2 groups after resuscitation. CONCLUSIONS： Dexmedetomidine 1 μg/kg in the priming solution could prevent transient hypotension of heart surgery patients at the beginning of CPB， and relieve the hypertension during CPB. |
| 期刊： | 2017年第28卷第2期 |
| 作者： | 汪芳俊，胡建华，杨霜，万勇，李洪琼 |
| AUTHORS： | WANG Fangjun，HU Jianhua，YANG Shuang，WAN Yong，LI Hongqiong |
| 关键字： | 右美托咪定；预充液；体外循环；血流动力学；平均动脉压 |
| KEYWORDS： | Dexmedetomidine； Priming solution； Cardiopulmonary bypass； Hemodynamics； MAP |
| 阅读数： | 247 次 |
| 本月下载数： | 2 次 |
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