摘要
目的 探讨右美托咪定辅助全身麻醉对老年非体外循环冠状动脉搭桥术(CABG)患者血流动力学、心肌保护效应及术后转归的影响.方法 前瞻性选取2021年6月至2023年6月邯郸市第一医院收治的110例非体外循环CABG患者,采用随机数字表法分为观察组和对照组,各55例.观察组给予右美托咪定辅助全身麻醉(麻醉诱导前15 min静滴0.6 μg/kg,以0.2～0.4μg·kg-1·h-1持续泵注至手术结束),对照组给予等体积0.9％氯化钠溶液,其余同观察组.比较两组患者麻醉前(T0)、穿刺完毕5 min(T1)、手术结束即刻(T2)与手术后12 h(T3)的围手术期血流动力学指标[血氧饱和度(SpO2)与平均动脉压(MAP)、心率],手术前、手术后24、48 h的心肌损伤标志物[肌钙蛋白T(CTnT)和肌酸激酶同工酶(CK-MB)],手术前、手术后6、12、24 h的认知功能[蒙特利尔认知评估量表(MoCA)评分],术后转归情况(气管拔管、ICU滞留、苏醒、定向力恢复与术后住院时间)及躁动发生率.结果 T0时,两组SpO2、MAP、心率比较,差异均无统计学意义(P＞0.05);T1、T2、T3时,观察组SpO2、MAP、心率均高于对照组,差异均有统计学意义(P＜0.05).手术后24、48 h,观察组的cTnT和CK-MB水平均低于对照组,差异均有统计学意义(P＜0.05).手术后6、12、24 h,观察组的 MoCA 评分分别为(26.65±1.41)、(27.58±1.11)、(28.69±1.15)分,均高于对照组[(25.31± 1.22)、(26.47±1.23)、(27.11±1.24)分],差异均有统计学意义(P＜0.05).两组苏醒时间、定向力恢复时间比较,差异均无统计学意义(P＞0.05),观察组气管拔管时间、ICU滞留时间、术后住院时间分别为(15.86±3.36)h、(51.39± 5.77)h、(11.39±2.48)d,均短于对照组[(19.75±3.41)h、(60.48±5.63)h、(13.65±2.61)d],差异均有统计学意义(P＜0.05).手术后6、24、48 h,观察组患者的躁动发生率分别为5.45％、3.64％、1.82％,均低于对照组(21.82％、16.36％、14.55％),差异均有统计学意义(P＜0.05).结论 右美托咪定辅助全身麻醉在老年非体外循环冠脉搭桥术患者中可稳定患者围术期血流动力学,减少心肌损害,改善患者早期认知功能,同时可促进患者术后转归,降低术后躁动发生率.
Abstract
Objective To investigate the effect of dexmedetomidine assisted general anesthesia on hemodynamics,myocardial protection and postoperative outcome in elderly patients undergoing off-pump coronary artery bypass graf(CABG).Methods A total of 110 patients un-dergoing off-pump CABG in Handan First Hospital from June 2021 to June 2023 were prospectively selected and divided into observation group and control group by random number table method,with 55 cases in each group.The the observation group was given dexmedetomidine assisted general anesthesia(0.6 μg/kg intravenous drip 15 min before anesthesia induction,and continuous infusion at 0.4 µg·kg-1·h-1 rate during the operation),the control group was given an equal volume of 0.9％sodium chloride solution,while the rest were the same as the observation group.The perioperative hemodynamic indexes[oxygen saturation of blood(SpO2),mean arterial blood pressure(MAP),heart rate)]before an-esthesia(T0),5 min after puncture(T1),immediately after operation(T2),and 12 h after operation(T3),myocardial injury marker[troponin T(CTnT),creatine kinase-MB(CK-MB)]before operation,24 and 48 h after operation,cognitive score[Montreal Cognitive Assessment(MoCA)score)]before operation,6,12,and 24 h after operation,postoperative outcome(tracheal extubation,ICU retention,recovery,orien-tation recovery and postoperative hospital stay)and the incidence of agitation were compared between the two groups.Results At T0,there were no statistically significant differences in SpO2,MAP,and heart rate between the two groups(P＞0.05);at T1,T2,and T3,the SpO2,MAP,and heart rate in the observation group were higher than those in the control group,and the differences were statistically significant(P＜0.05).At 24 and 48 h after operation,the levels of cTnT and CK-MB in the observation group were lower than those in the control group,and the differ-ences were statistically significant(P＜0.05).At 6,12 and 24 h after operation,the MoCA scores of the observation group were(26.65±1.41),(27.58±1.11),(28.69±1.15)points,respectively,which were higher than those of the control group[(25.31±1.22),(26.47±1.23),(27.11±1.24)points],and the differences were statistically significant(P＜0.05).There were no significant differences in recovery time and orientation recovery time between the two groups(P＞0.05),the time of tracheal extubation,ICU retention and postoperative hospital stay in the observation group were(15.86±3.36)h,(51.39±5.77)h,(11.39±2.48)d,respectively,which were shorter than those in the control group[(19.75±3.41)h,(60.48±5.63)h,(13.65±2.61)d],and the differences were statistically significant(P＜0.05).At 6,24,and 48 h after operation,the restlessness rates of the observation group patients were 5.45％,3.64％,and 1.82％,respectively,which were lower than those of the control group(21.82％,16.36％,and 14.55％),and the differences were statistically significant(P＜0.05).Con-clusion Dexmedetomidine assisted general anesthesia can stabilize perioperative hemodynamics,reduce myocardial damage,improve early cogni-tive function,promote postoperative outcome and reduce the incidence of postoperative agitation in elderly patients undergoing off-pump coronary artery bypass grafting.
基金项目
河北省卫生健康委员会2023年度医学科学研究课题(20231914)
NETL
NSTL
维普
万方数据