王志杰;刚绍鹏;方开云;马熠;
WANG Zhijie;GANG Shaopeng;FANG Kaiyun;MA Yi;Department of Anesthesiology,the Affiliated People's Hospital of Guiyang Medical University;Department of Anesthesiology,Guizhou Provincial People's Hospital;

• 1:贵州医科大学附属省人民医院麻醉学教研室
• 2:贵州省人民医院麻醉科

摘要(Abstract)：

目的:比较右美托咪定和七氟醚对心脏瓣膜置换术患者术中血流动力学的影响。方法:选择全麻下行心脏瓣膜置换术的风湿性心脏病患者65例,ASA分级Ⅲ~Ⅳ级,随机分为右美托咪定组(D组n=33)和七氟醚组(S组n=32),D组于诱导插管后持续泵注右美托咪定至术毕,S组全程持续吸入七氟醚,体外循环期间用七氟醚专用挥发罐持续吸入循环维持麻醉深度;记录麻醉诱导前(T1)、诱导后10 min(T2)、升主动脉阻断后10 min(T3)、降温至鼻咽温30℃平稳后10 min(T4)、停机后10 min(T5)、术毕(T6)6个时间点的心率(HR)、收缩压(SP)、舒张压(DP)和平均动脉压(MAP);比较两组患者舒芬太尼、去甲肾上腺素及硝酸甘油用量。结果:T3、T4时点D组SP、DP及MAP均高于S组(P<0.05),D组硝酸甘油用量高于S组(P<0.05),舒芬太尼及去甲肾上腺素用量两组比较差异无统计学意义(P>0.05)。结论:右美托咪定可安全用于体外循环心脏瓣膜置换术患者,且在体外循环初期,其对血流动力学的维持优于七氟醚。
Objective: To compare clinical effects of dexmedetomidine and sevoflurane on the intraoperative hemodynamics in patients with the cardiact valve replacement. Methods: 65 ASA Ⅱ ~ Ⅳ patients,aged 18 ~ 64 years and undergoing cardiac valve replacement,were randomly divided into two groups: group of dexmedetomidine( group D,n = 33) and group of sevoflurane( group S,n = 32). After induction and intubation,group D received continuous pump injection of dexmedetomidine to the end of operation. Group S inhaled sevoflurane in whole process of operation,and during cardiopulmonary bypass( CPB) were given continuous inhalation cycle by special sevoflurane vaporizer to maintain the depth of anesthesia. At six time points including T1( before anesthesia induction),T2( 10 min after induction),T3( 10 min after ascending aorta block),T4( 10 min after cooling to 30 ℃ stationary),T5( 10 min after downtime) and T6( end of the surgery),heart rate( HR),systolic blood pressure( SP),diastolic pressure( DP) and mean arterial pressure( MAP) were recorded. The dosage of sufentanil,norepinephrine,and nitroglycerin were compared between the two groups. Results: The SP,DP and MAP at T3,T4 in group D were significantly higher than in group S( P < 0. 05). Nitroglycerin dosage in group D was higher than in group S while there was no statistically significant difference in dosage of sufentanil and norepinephrine between group S and group D( P > 0. 05). Conclusion: Dexmedetomidine is safe for patients in vitro circulation cardiac valve replacement,and in the early period of cardiopulmonary bypass dexmedetomidine is better than sevoflurane for maintainance of hemodynamics.

关键词(KeyWords)： 右美托咪定;七氟醚;血流动力学;体外循环;心脏外科手术
dexmedetomidine;sevoflurane;hemodynamics;extracorporeal circulation;cardiac surgical procedures

Abstract:

Keywords:

基金项目(Foundation): 贵州省社会发展攻关项目[黔科合SY字(2012)3111];; 贵阳市科技计划[筑科合同(2013103)33号];; 贵州省科技合作计划[黔科合LH字(2015)7141];; 贵州省人民医院博士基金项目[GZSYBS(2015)05号]

作者(Author): 王志杰;刚绍鹏;方开云;马熠;
WANG Zhijie;GANG Shaopeng;FANG Kaiyun;MA Yi;Department of Anesthesiology,the Affiliated People's Hospital of Guiyang Medical University;Department of Anesthesiology,Guizhou Provincial People's Hospital;

Email:

DOI: 10.19367/j.cnki.1000-2707.2016.07.022

参考文献(References)：

• [1]Karakaya KH,Sshin N,Temel Y,et al.Hemodynamics in coronary artery bypass surgery:effects of intraoperative dexmedetomidine administration[J].Anaesthesist,2011(5):427-431.
• [2]Ji F,Li Z,Young N,et al.Perioperative dexmedetomidine improves mortality in patients undergoing coronary artery bypass surgery[J].Cardiothorac Vasc Anesth,2014(2):267-273.
• [3]徐美英,于布为.心脏瓣膜置换术中七氟醚复合麻醉对血流动力学的影响[J].中华麻醉学杂志,1994(3):212-214.
• [4]Ji FH,Li ZM,Nguyen H,et al.Perioperative dexmedetomidine improves outcomes of cardiac surgery[J].Circulation,2013(15):1576-1584.
• [5]Elias WJ,Durieux ME,Huss D,et al.Dexmedetomidine and arousal affect subthalamic neurons[J].Mov Disord,2008(23):1317-1320.
• [6]But AK,Ozgul U,Erdil F,et al.The effects of pre-operative dexmedetomidine infusion on hemodynamics in patients with puhnonary hypertension undergoing mitral valve replacement surgery[J].Acta Anaesthesiol Scand,2006(10):1207-1212.
• [7]张加强,孟凡民.右美托咪定对七氟醚麻醉诱导时患者躁动及应激反应的影响[J].临床麻醉学杂志,2013(2):194-195.
• [8]Patel CR,Engineer SR,Shah BJ,et a1.The effect of dexmedetomidine continuous infusion as an adjuvant to general anesthesia onsevoflurane requirements:A study based on entropy analysis[J].J Anaesthesiol Clin Pharmacol,2013(3):318-322.

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