Chi Xiaohui, Liao Mingfeng, Chen Xin, Zhao Yilin, Yang Liu, Luo Ailin, Yang Hui
Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China.
Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China.
J Cardiothorac Vasc Anesth. 2016 Jan;30(1):44-50. doi: 10.1053/j.jvca.2015.06.026. Epub 2015 Jun 26.
To investigate the cardioprotective effect of the continuous administration of dexmedetomidine using serum cardiac troponin I (cTnI) and creatine kinase MB (CK-MB) concentrations as biomarkers during off-pump coronary artery bypass grafting (OPCAB) surgery.
A prospective, randomized, parallel-group controlled study.
A university hospital.
One hundred sixteen patients undergoing OPCAB surgery.
Patients were divided randomly into 3 experimental groups that were separated by the dexmedetomidine administration protocol: a high-dose group (loading dose, 1 μg/kg; maintenance dose, 0.6 μg/kg/h); low-dose group (loading dose, 0.6 μg/kg; maintenance dose, 0.3 μg/kg/h); and control group (the same amount of 0.9% saline as placebo). Serum cTnI and CK-MB levels were measured before surgery and 24 hours and 48 hours after surgery.
Serum cTnI and CK-MB levels in patients of the high-dose group were less than those of the other 2 groups 48 hours after surgery. The administration of dexmedetomidine significantly decreased the heart rate. Compared with the control group, there was a significantly reduced requirement of sevoflurane in the other 2 groups (p<0.05). The intraoperative and postoperative cumulative volumes of urine output in the high-dose group were greater than those of the other 2 groups (p<0.05). The authors also found that the extubation time and length of stay in the intensive care unit were prolonged in the high-dose group.
Myocardial damage was reduced by the administration of a 1 μg/kg loading dose and a 0.6 μg/kg/h infusion dose of dexmedetomidine. However, further studies are needed to understand the underlying mechanism and to confirm that high doses of dexmedetomidine could be administered safely in patients undergoing OPCAB surgery.
在非体外循环冠状动脉搭桥术（OPCAB）手术期间，以血清心肌肌钙蛋白I（cTnI）和肌酸激酶同工酶MB（CK-MB）浓度作为生物标志物，研究持续输注右美托咪定的心脏保护作用。
一项前瞻性、随机、平行组对照研究。
一所大学医院。
116例行OPCAB手术的患者。
患者随机分为3个实验组，根据右美托咪定给药方案分组：高剂量组（负荷剂量，1μg/kg；维持剂量，0.6μg/kg/h）；低剂量组（负荷剂量，0.6μg/kg；维持剂量，0.3μg/kg/h）；对照组（等量0.9%生理盐水作为安慰剂）。在手术前、手术后24小时和48小时测量血清cTnI和CK-MB水平。
术后48小时，高剂量组患者的血清cTnI和CK-MB水平低于其他两组。右美托咪定的给药显著降低了心率。与对照组相比，其他两组七氟醚的需求量显著减少（p<0.05）。高剂量组术中及术后累计尿量大于其他两组（p<0.05）。作者还发现，高剂量组的拔管时间和重症监护病房住院时间延长。
给予1μg/kg负荷剂量和0.6μg/kg/h输注剂量的右美托咪定可减轻心肌损伤。然而，需要进一步研究以了解其潜在机制，并确认高剂量右美托咪定在接受OPCAB手术的患者中能否安全给药。
