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中国人民解放军总医院老年心血管病研究所
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
陈熙,肖如红,徐栋,张忠.不同剂量右美托咪啶对非体外循环下冠状动脉旁路移植手术中熵指数和血流动力学的影响[J].中华老年多器官疾病杂志,2019,18(4):241~246
不同剂量右美托咪啶对非体外循环下冠状动脉旁路移植手术中熵指数和血流动力学的影响
Effects of dexmedetomidine at different dosages on entropy index and hemo-dynamics during off-pump coronary artery bypass grafting
投稿时间:2018-10-16  
DOI:10.11915/j.issn.1671-5403.2019.04.049
中文关键词:  右美托咪啶;冠状动脉旁路移植术,非体外循环;熵指数;血流动力学
英文关键词:dexmedetomidine; coronary artery bypass grafting, off-pump; entropy index; hemodynamics
基金项目:湖南省卫生计生委计划项目(B2016180)
作者单位E-mail
陈熙 湖南省岳阳市第一人民医院麻醉科,岳阳 414000  
肖如红 湖南省岳阳市第一人民医院麻醉科,岳阳 414000  
徐栋 湖南省岳阳市第一人民医院心胸外科,岳阳 414000  
张忠 湖南省岳阳市第一人民医院麻醉科,岳阳 414000 two196876661@sohu.com 
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中文摘要:
      目的 探讨不同剂量右美托咪啶(DEX)在非体外循环下冠状动脉旁路移植术(OPCAB)中对熵指数和血流动力学的影响。方法 选择2016年6月至2017年12月岳阳市第一人民医院心胸外科接受OPCAB的患者80例,根据随机数表法分为A、B、C及D 4组,每组20例。麻醉诱导前B、C及D 3组患者分别静注DEX负荷量0.5、0.7和1.0 μg/kg(均为50 ml,10 min输注完毕),A组静注50 ml生理盐水。随后B、C及D 3组分别以0.5、0.7、1.0 μg/(kg·h)维持剂量持续输注至关胸,A组不作处理。4组患者经麻醉诱导插管进行机械通气,并行右颈内静脉穿刺技术。比较4组患者给药前(T0)、给药后插管时(T1)、开胸后(T2)、吻合血管后心脏位置复原后(T3)反应熵(RE)、状态熵(SE)及血流动力学[中心静脉压(CVP)、心脏指数(CI)、胸腔内血容量指数(ITBI)和全身外周血管阻力指数(SVRI)]变化。采用SPSS 19.0统计软件对数据进行分析。根据数据类型,组间比较采用单因素方差分析、LSD-t检验或χ2检验。结果 与T0比较,4组患者在T1~3时RE、SE显著下降;与T1比较,4组患者在T2~3的RE、SE显著下降,差异有统计学意义(P<0.05)。与A组比较,B、C、D组在T1~3的RE、SE均显著下降;与B组比较,C、D组在T1~3的RE、SE亦显著下降,差异有统计学意义(P<0.05)。与T0时比较,T1时A、C、D组患者的CVP显著升高,4组患者的CI、ITBI、SVRI显著下降;T2~3时A、C、D组患者CVP显著上升,C、D组患者CI、ITBI、SVRI显著下降,差异有统计学意义(P<0.05)。与T1时比较,T2~3时A、C、D组患者的CVP显著下降;C、D组患者的CI、ITBI、SVRI显著升高,差异有统计学意义(P<0.05)。与A组或B组比较,T2~3时C和D组患者的CVP均显著升高,CI显著降低,差异均有统计学意义(P<0.05)。T0~3期间C、D组之间上述指标差异均无统计学意义。结论 DEX可以提高OPCAB手术麻醉效果,改善熵指数,其中应用0.7 μg/kg剂量组对该手术血流动力学稳定效果最佳。
英文摘要:
      Objective To investigate the effect of dexmedetomidine (DEX) at different dosages on entropy index and hemodynamics during off-pump coronary artery bypass grafting (OPCAB). Methods From June 2016 to December 2017,0 patients undergoing OPCAB in the Department of Cardiothoracic Surgery of the First People′s Hospital of Yueyang were selected and randomized into groups A, B, C and D, with 20 in each group. Before anesthesia induction, groups B, C and D were given DEX at 0.5,0.7 and 1.0 μg/kg (50 ml, 10 min) respectively, and group A was given 50 ml saline. Subsequently, DEX was infused at 0.5,0.7, and 1.0 μg/(kg·h) respectively in groups B, C and D until chest closure, while group A was not treated. Mechanical ventilation was performed by anesthesia induction and followed by the right internal jugular vein puncture in 4 groups. The 4 groups were compared in the respects of response entropy (RE), state entropy (SE) and hemodynamics [central venous pressure (CVP), cardiac index (CI), intrathoracic blood volume index (ITBI) and systemic vascular resistance index (SVRI)]before administration (T0), after intubation (T1), after thoracotomy (T2), after cardiac reposition (T3). SPSS statistics 19.0 was used to analyze the data. According to the data type, single factor variance analysis, LSD-t test or χ2 test was used for comparison among groups. Results Compared with T0, RE and SE decreased significantly at T1-3 in all 4 groups, and compared with T1, RE and SE decreased significantly at T2-3 in all 4 groups (P<0.05). RE and SE in group B, C and D were significantly lower than group A at T1-3, and RE and SE in group C and D were significantly lower than group B at T1-3 (P<0.05). Compared with T0, CVP in group A, C and D increased significantly, and CI, ITBI and SVRI in 4 groups decreased significantly at T1; CVP in group A, C and D increased significantly, and CI, ITBI and SVRI in group C and D decreased significantly at T2-3 (P<0.05). Compared with T1, CVP in group A, C and D decreased significantly at T2-3, and CI, ITBI and SVRI in group C and D increased significantly, with significant difference(P<0.05). Compared with group A or B, CVP in group C and D increased significantly and CI decreased significantly at T2-3 (P<0.05). There was no difference between C and D in terms of those indices above all. Conclusion DEX is able to enhance anesthesia and entropy index of OPCAB, and a dosage at 0.7 μg/kg offers the best effect for hemodynamic stability.
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