不同剂量右美托咪定对非体外循环冠状动脉旁路移植术患者循环系统、应激反应的影响

doi:10.3969/j.issn.1006-5725.2024.11.018

Abstract

Abstract:

Objective To observe the effects of different administration doses of dexmedetomidine on the circulatory system and stress response in patients undergoing extracorporeal coronary artery bypass grafting （OPCABG）. Methods Ninety-six patients who underwent OPCABG in our hospital from October 2021 to October 2023 were selected and divided into two groups using simple randomization method. Group A was administered dexmedetomidine at a dose of 0.5 μg/kg over 10 minutes before anesthesia induction， followed by a maintenance dose of 0.5 μg/（kg·h） infused until the end of the surgery， while group B was administered dexmedetomidine at a dose of 0.8 μg/kg for 10 min before anesthesia induction， followed by a maintenance dose of 0.8 μg/（kg·h） until the end of the operation. The two groups were compared in terms of cardiac index （CI）， heart rate， mean arterial pressure （MAP）， intrathoracic blood volume index （ITBI）， bispectral index （BIS）， and systemic peripheral vascular resistance index （SVRI） before anesthesia started （T0）， at the immediate moment of intubation （T1）， at the immediate moment of the start of the surgery （T2）， at the time of sawing of the sternum （T3）， and at the immediate moment of extubation （T4）. Additionally， the two groups were compared in terms of cortisol （Cor）， Angiotensin Ⅱ （Ang Ⅱ） levels， safety and postoperative awakening time. Results The two groups showed no differences in operation time， anaesthesia time， bleeding and urine volume （P > 0.05）， but group B demonstrated less intraoperative use of cisatracurium compared to group A （P < 0.05）. At T0， the two groups showed no difference in heart rate and MAP （P > 0.05）， but higher heart rate and MAP at T1 and T3 than at T0. Group A was observed to have higher heart rate and MAP at T4 than at T0， while group B showed no significant differences in heart rate and MAP at T4 compared to them at T0 （P > 0.05）. At T2 and T4， Group B showed significantly lower heart rate and MAP compared to group A （P < 0.05）. At T0， the two group had no differences in terms of CI， CO， ITBI， and SVRI （P > 0.05）. Both groups showed significantly lowered levels of CI， CO， ITBI， and SVRI at T1-T4 than at T0 （P < 0.05）， but demonstrated no differences in the levels of CI， CO， ITBI， SVRI at T0-T4 （P > 0.05）. At T0， both groups had no difference in BIS values （P > 0.05）， but showed significantly decreased BIS values at T1-T4 compared with those at T0 （P < 0.05）. At T2-T4， group A showed significantly lower BIS values compared with group A （P < 0.05）. The two groups had no difference in postoperative awakening time compared with group A （8.12 ± 1.88 min vs. 8.05 ± 1.97 min， P > 0.05）. Preoperatively， the two groups had no differences in Cor and Ang Ⅱ（P > 0.05）. However， at 6 h postoperatively， both groups showed significantly elevated Cor and AngⅡ values compared to preoperatively （P < 0.05）， and group B showed signifantly lower values of Cor and AngⅡ compared to group A （P < 0.05）. The two groups had no difference in the adverse reactions （6.25% vs. 8.33%， P > 0.05）. Conclusion Dexmedetomidine administered at the dose of 0.8 μg/（k·h） rather than at the dose of 0.5 μg/（k·h） for managing OPCABG results in more stable hemodynamics during surgery， yielding better sedative effect， milder postoperative stress response， and no increase in adverse reactions.

Key words: dexmedetomidine, dosage, non-extracorporeal coronary artery bypass grafting, stress, hemodynamics, adverse effects

CLC Number:

R541.4

Jing XIE,Dong GUO,Shiqiang FENG,Yi ZHAO,Hong LI,Zhenhua. QU. Effect of different administration doses of dexmedetomidine on the circulatory system and stress response in patients undergoing coronary artery bypass grafting with noncorporeal circulation[J]. The Journal of Practical Medicine, 2024, 40(11): 1574-1579.

Figures/Tables 7

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

References 23

1	MARX N. Koronare Herzkrankheit［J］.Dtsch Med Wochenschr，2021，146（16）：1021. doi:10.1055/a-1220-8144 doi: 10.1055/a-1220-8144
2	KATTA N， LOETHEN T， LAVIE C J， et al. Obesity and Coronary Heart Disease： Epidemiology， Pathology， and Coronary Artery Imaging［J］. Curr Probl Cardiol， 2021，46（3）：100655. doi:10.1016/j.cpcardiol.2020.100655 doi: 10.1016/j.cpcardiol.2020.100655
3	ALPERT J S. New Coronary Heart Disease Risk Factors［J］.Am J Med， 2023，136（4）：331-332. doi:10.1016/j.amjmed.2022.08.002 doi: 10.1016/j.amjmed.2022.08.002
4	OFOEGBU C， MANGANYI R M. Off-Pump Coronary Artery Bypass Grafting； is it Still Relevant？［J］. Curr Cardiol Rev， 2022，18（2）：e438257783. doi:10.2174/1573403x17666211027141043 doi: 10.2174/1573403x17666211027141043
5	MEGURO S， HAGA N， IMAI H， et al. Association Between Surgical Stress and Biochemical Recurrence After Robotic Radical Prostatectomy［J］. JSLS， 2021，25（1）：e2020-e2078. doi:10.4293/jsls.2020.00078 doi: 10.4293/jsls.2020.00078
6	MEI B， LI J， ZUO Z. Dexmedetomidine attenuates sepsis-associated inflammation and encephalopathy via central α2A adrenoceptor［J］. Brain Behav Immun， 2021，91：296-314. doi:10.1016/j.bbi.2020.10.008 doi: 10.1016/j.bbi.2020.10.008
7	TASBIHGOU S R， BARENDS C R M， ABSALOM A R. The role of dexmedetomidine in neurosurgery［J］. Best Pract Res Clin Anaesthesiol， 2021，35（2）：221-229. doi:10.1016/j.bpa.2020.10.002 doi: 10.1016/j.bpa.2020.10.002
8	POON W H， LING R R， YANG I X， et al. Dexmedetomidine for adult cardiac surgery： a systematic review， meta-analysis and trial sequential analysis［J］. Anaesthesia， 2023，78（3）：371-380. doi:10.1111/anae.15947 doi: 10.1111/anae.15947
9	张芮，王志涛，刘德君，等. 不同剂量右美托咪定对瑞马唑仑致患者意识消失ED95及应激反应的影响［J］. 实用医学杂志，2023，39（4）：476-480. doi:10.3969/j.issn.1006-5725.2023.04.016 doi: 10.3969/j.issn.1006-5725.2023.04.016
10	葛均波，徐永健. 内科学［M］. 8版. 北京：人民卫生出版社，2013：273.
11	BONACCHI M， HOWE R， MICALI L R， et al. Off-Pump Coronary Artery Bypass Reduces Cardiac Death in Patients with Peripheral Arteriopathy［J］. J Thorac Cardiovasc Surg， 2021，69（7）：614-620. doi:10.1055/s-0041-1724036 doi: 10.1055/s-0041-1724036
12	FAN G， WANG X， CHEN C， et al. Surgeons′ Preference for Off-Pump or On-Pump Coronary Artery Bypass Grafting Surgery［J］. Heart Surg Forum， 2021，24（3）：E422-E426. doi:10.1532/hsf.3747 doi: 10.1532/hsf.3747
13	BIANCO V， KILIC A， GELZINIS T， et al. Off-Pump Coronary Artery Bypass Grafting： Closing the Communication Gap Across the Ether Screen［J］. J Cardiothorac Vasc Anesth， 2020，34（1）：258-266. doi:10.1053/j.jvca.2019.05.005 doi: 10.1053/j.jvca.2019.05.005
14	JADHAV J A， MANKHAIR S， CHAKOLE V. Comparative Evaluation of Dexmedetomidine and Magnesium Sulfate for Prevention of Postoperative Atrial Fibrillation in Patients of Coronary Artery Bypass Surgeries［J］. Cureus， 2023，15（6）：e41075.
15	TASBIHGOU S R， BARENDS C R M， ABSALOM A R. The role of dexmedetomidine in neurosurgery［J］. Best Prac Res Clin Anaesthesiol， 2021，35（2）：221-229. doi:10.1016/j.bpa.2020.10.002 doi: 10.1016/j.bpa.2020.10.002
16	杨逸成，陈贝儿，叶凯雁，等. 右美托咪定的心脏保护机制及其临床应用价值［J］. 中国医学科学院学报， 2022，44（1）：130-135.
17	秦卫民，郑龙彬，尹宁，等. 预注不同负荷剂量右美托咪定在腹腔镜胆囊切除术中的应用［J］. 临床麻醉学杂志， 2022，38（2）：134-138.
18	LIAQUAT Z， XU X， ZILUNDU P L M， et al. The Current Role of Dexmedetomidine as Neuroprotective Agent： An Updated Review［J］. Brain Sci， 2021，11（7）：846. doi:10.3390/brainsci11070846 doi: 10.3390/brainsci11070846
19	VUKICEVIC P， KLISIC A， NESKOVIC V， et al. Oxidative Stress in Patients before and after On-Pump and Off-Pump Coronary Artery Bypass Grafting： Relationship with Syntax Score［J］. Oxid Med Cell Longev， 2021，2021：1-9. doi:10.1155/2021/3315951 doi: 10.1155/2021/3315951
20	周红刚，解成兰，薛雷，等. 不同剂量右美托咪定术后滴鼻对小儿扁桃体腺样体切除术患者血流动力学及咽痛的影响［J］. 解放军医学院学报， 2020，41（10）：988-991，996. doi:10.3969/j.issn.2095-5227.2020.10.008 doi: 10.3969/j.issn.2095-5227.2020.10.008
21	OKAMOTO A， KAMATA K， MIYATA T， et al. Bispectral index-guided propofol sedation during endoscopic ultrasonography［J］. Clin Endosc， 2022，55（4）：558-563. doi:10.5946/ce.2022.001 doi: 10.5946/ce.2022.001
22	CHIMA A M， MAHMOUD M A， NARAYANASAMY S. What Is the Role of Dexmedetomidine in Modern Anesthesia and Critical Care？［J］. Adv Anesth， 2022，40（1）：111-130. doi:10.1016/j.aan.2022.06.003 doi: 10.1016/j.aan.2022.06.003
23	XIAO S， WANG Q， GAO H， et al. Dexmedetomidine alleviates airway hyperresponsiveness and allergic airway inflammation through the TLR4/NF‑κB signaling pathway in mice［J］. Mol Med Rep， 2022，25（3）：74. doi:10.3892/mmr.2022.12590 doi: 10.3892/mmr.2022.12590

一般资料	A组（n = 48）	B组（n = 48）	χ²/t值	P值
年龄（岁）	61.41 ± 7.96	62.01 ± 7.44	0.382	0.704
体质量（kg）	58.22 ± 6.11	57.96 ± 6.43	0.203	0.840
男性［例（%）］	27（56.25）	25（52.08）	0.168	0.682
LVEF（%）	51.04 ± 3.67	50.69 ± 4.07	0.442	0.659
NYHA分级（例）			0.389	0.533
Ⅱ级	30	27
Ⅲ级	18	21
ASA分级（例）			0.383	0.536
Ⅱ级	29	26
Ⅲ级	19	22
术前用药［例（%）］
β-受体阻滞剂	47（97.92）	46（95.83）	0.344	0.557
血管紧张素转换酶抑制剂	35（72.92）	39（81.25）	0.944	0.331
硝酸酯类药物	46（95.83）	45（93.75）	0.211	0.646
钙离子拮抗剂	17（35.42）	22（45.83）	1.080	0.299

组别	例数	手术时间（min）	麻醉时间（min）	出血量（mL）	尿量（mL）
A组	48	190.52±25.63	268.96±57.41	605.52±68.96	654.74±62.82
B组	48	186.14±26.43	271.23±52.22	597.41±70.27	661.14±59.99
t值		0.824	0.203	0.285	0.510
P值		0.412	0.840	0.570	0.611

指标	时间	A组（n = 48）	B组（n = 48）	t值	P值
心率（次/min）
	T0	71.85±4.05	72.14±3.91	0.357	0.722
	T1	74.14±4.74^*	74.22±4.42^*	0.086	0.932
	T2	76.11±4.36^*	73.83±4.14^*	2.627	0.010
	T3	83.63±5.15^*	74.04±4.76^*	9.474	0.000
	T4	76.04±4.63^*	73.08±4.09	3.320	0.001
MAP（mmHg）
	T0	81.85±5.67	80.79±6.11	0.881	0.381
	T1	84.47±6.14^*	82.41±5.17^*	1.778	0.079
	T2	86.14±5.22^*	82.74±4.93^*	3.281	0.001
	T3	89.33±5.47^*	84.23±5.17^*	4.695	0.000
	T4	84.47±4.55^*	82.09±5.63	2.278	0.025

指标	时间	A组（n = 48）	B组（n = 48）	t值	P值
CI［L/（min·m²）］
	T0	3.65 ± 0.34	3.61 ± 0.38	0.543	0.588
	T1	3.02 ± 0.26^*	2.94 ± 0.24^*	1.566	0.121
	T2	3.10 ± 0.27^*	3.05 ± 0.26^*	0.924	0.358
	T3	3.12 ± 0.33^*	3.08 ± 0.30^*	0.621	0.536
	T4	3.07 ± 0.29^*	3.02 ± 0.28^*	0.859	0.392
ITBI（mL/m²）
	T0	654.14 ± 68.95	651.41 ± 72.05	0.190	0.85
	T1	567.96 ± 61.04^*	572.25 ± 59.83^*	0.348	0.729
	T2	584.52 ± 65.08^*	590.13 ± 67.44^*	0.415	0.679
	T3	579.63 ± 62.73^*	584.05 ± 63.76^*	0.342	0.733
	T4	604.14 ± 62.14^*	610.13 ± 67.43^*	0.453	0.652
SVRI［kPa·s/（L·m²）］
	T0	2 098.52 ± 741.56	2 104.56 ± 709.64	0.041	0.968
	T1	1 302.05 ± 675.95^*	1 334.52 ± 672.04^*	0.236	0.814
	T2	1 327.85 ± 615.41^*	1 352.08 ± 598.86^*	0.195	0.845
	T3	1 308.56 ± 597.12^*	1 312.24 ± 602.08^*	0.030	0.976
	T4	1 356.96 ± 601.74^*	1 378.85 ± 594.82^*	0.179	0.858

组别	例数	T0	T1	T2	T3	T4
A组	48	92.14 ± 4.56	47.12 ± 4.83^*	48.14 ± 5.07^*	50.04 ± 6.12^*	52.32 ± 5.47^*
B组	48	91.37 ± 5.07	46.89 ± 4.97^*	45.87 ± 4.73^*	46.77 ± 5.82^*	47.01 ± 4.86^*
t值		0.782	0.230	2.298	2.683	5.028
P值		0.436	0.819	0.024	0.009	0.000

Effect of different administration doses of dexmedetomidine on the circulatory system and stress response in patients undergoing coronary artery bypass grafting with noncorporeal circulation

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 7

References 23

Related Articles 15

Recommended Articles

Metrics

Comments

组别	例数	Cor（mmol/L）		AngⅡ（ng/L）
组别	例数	术前	术后6 h	术前	术后6 h
A组	48	70.84 ± 8.69	127.85 ± 12.17^*	38.98 ± 6.74	54.76 ± 7.84^*
B组	48	72.04 ± 8.17	118.41 ± 8.25^*	39.04 ± 7.21	47.04 ± 6.22^*
t值		0.697	4.448	0.042	5.344
P值		0.488	0.000	0.966	0.000

组别	呼吸抑制	恶心呕吐	躁动	低血压	尿潴留	累计不良反应
A组	0（0.00）	2（4.17）	1（2.08）	0（0.00）	0（0.00）	3（6.25）
B组	0（0.00）	3（6.25）	0（0.00）	0（0.00）	1（2.08）	4（8.33）
矫正检验值						0.000
P值						1.000

[1]	Bao WANG,Shulin MA,Xinhua YAO,Fan YANG,Kai WEN,Sijing LUO,Ying GAN,Yi. LU. Effect of intraoperative electroacupuncture analgesia on stress response to tracheal intubation in patients undergoing thyroid surgery under general anesthesia [J]. The Journal of Practical Medicine, 2024, 40(8): 1132-1136.
[2]	Jinyan FAN,Lili CHEN,Su LIU,Chuanwu ZHANG,Zhen′ang MENG,Guanglei. WANG. Effect of nalbuphine hydrochloride combined with dexmedetomidine on post⁃operative recovery quality and pain in patients undergoing laparoscopic bariatric surgery [J]. The Journal of Practical Medicine, 2024, 40(7): 996-1001.
[3]	Rong SHI,Xianfang ZHENG,Qun TAO,Junmo CHEN,Xiaohua GE. Effect of laparoscopic salpingectomy on ovarian reserve function and serum neuropeptide Y and cortisol in patients with ectopic pregnancy [J]. The Journal of Practical Medicine, 2024, 40(6): 801-806.
[4]	Bo YANG,Zhaoquan. JIN. The clinical efficacy of sivelestat sodium combined with ulinastatin for sepsis⁃induced acute respiratory distress syndrome [J]. The Journal of Practical Medicine, 2024, 40(5): 621-626.
[5]	Kanglin CAI,Jinkai ZHANG,Liangdi RAN,Dajun HU,Zhitao FENG,Huilian. HUANG. Research progress on antidepressant pharmacological effects and mechanisms of Bupleuri Radix⁃Paeoniae Radix Alba herb⁃pair [J]. The Journal of Practical Medicine, 2024, 40(4): 447-452.
[6]	Jingcai WANG,Chunyan GUO,Lixin YANG,Xiaoqing. JING. Correlation of serum RAGE and HMGB1 expression with the occurrence of acute respiratory distress syndrome and IFN⁃γ/IL⁃4 ratio in patients with severe pneumonia [J]. The Journal of Practical Medicine, 2024, 40(4): 515-520.
[7]	Aiqin LI,Zhen ZHANG,Ya′nan XU,Jinyuan ZHU,Xu. ZHANG. Research progress on the interaction between macro⁃phages and fibroblasts in ARDS pulmonary fibrosis [J]. The Journal of Practical Medicine, 2024, 40(4): 571-574.
[8]	Yuncan WANG,Guangyun CAO,Haibo WU,Na WANG. The relationship between internal carotid artery wall shear stress and carotid plaque neovascularization was evaluated by carotid color ultrasound [J]. The Journal of Practical Medicine, 2024, 40(22): 3232-3237.
[9]	Tianyue YU,Qian GUO,Hao HU,Yujing SU,Jianhua CHEN. Advances in oxidative stress⁃related pathways with diagnostic and predictive value in schizophrenia [J]. The Journal of Practical Medicine, 2024, 40(20): 2935-2940.
[10]	Jieqiong LIU,Yali YAO,Qian SUI,Ke LI,Fang HUANG,Yongqing. CAO. Based on the novel anti-heart failure drug ARNI， the mechanism of prevention of cardiotoxicity caused by anthracycline antitumor drugs was discussed [J]. The Journal of Practical Medicine, 2024, 40(2): 188-194.
[11]	Feng ZHOU,Qixiang YIN,Faxing WEI,Haimin LIN,Huazhong CAI,Yikun. CHEN. The value of serum AQP1 level combined with EVLWI in assessing the severity and prognosis of ARDS due to sepsis [J]. The Journal of Practical Medicine, 2024, 40(17): 2483-2488.
[12]	Zhiyan XU,Weiyuan CHEN,Weifeng. YAO. Mechanism and research progress of dexmedetomidine in improving perioperative neurocognitive disorder in frail elderly patients [J]. The Journal of Practical Medicine, 2024, 40(17): 2503-2507.
[13]	Ganggang LU,Shenglong LI,Yongqiang ZHAO,Yunpeng JIA,Yonglin LIANG,Yuanbo. ZHAO. Research progress on the correlation between oxidative stress and ferroptosis in diabetic impotence [J]. The Journal of Practical Medicine, 2024, 40(16): 2229-2235.
[14]	Yunlong SUN,Zhe MENG,Xijia WANG,Lu. GAO. Liraglutide ameliorates high glucose⁃induced endothelial cell injuryvia Nrf2 [J]. The Journal of Practical Medicine, 2024, 40(15): 2051-2055.
[15]	Yong YANG,Renjun CHEN,Jianling GE,Wei. WANG. The protective effect of dexmedetomidine on sevoflurane⁃induced cognitive impairment based on the Wnt/β⁃catenin signaling pathway [J]. The Journal of Practical Medicine, 2024, 40(15): 2063-2068.