Hegazy Mohammed Adel, Hegazi Refaat Abdelfattah, Hendawy Shimaa Rabea, Hussein Mohamed Salah, Abdellateef Amr, Awad Geha, Abdeldayem Ola Taha
Department of Anesthesia and Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Community Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Anesth Essays Res. 2020 Apr-Jun;14(2):312-320. doi: 10.4103/aer.AER_55_20. Epub 2020 Oct 12.
Myocardial damage due to ischemia and reperfusion is still unavoidable during coronary surgery. Anesthetic agents have myocardial preconditioning effect. Ketamine has sympathomimetic effect, while dexmedetomidine has a sympatholytic effect in addition to anesthetic, analgesic, and anti-inflammatory properties of both the drugs. This study was carried out to compare ketamine-dexmedetomidine (KD) combination with fentanyl-propofol (FP) combination on the release of cardiac troponin T (cTnT) and outcome after coronary artery bypass graft.
Ninety adult patients who underwent coronary artery bypass grafting (CABG) were assigned to receive either KD base anesthesia (KD group) or FP anesthesia (FP group). Trends of high-sensitive cTnT, CK-MB, and serum cortisol were followed in the first postoperative 24 h. Other outcomes were vital signs, weaning from cardiopulmonary bypass, tracheal extubation time, and echocardiographic findings.
There was a significant lower release of cTnT in KD group than FP group during its peak values at 6 h after aortic unclamping (92.01 ± 7.332 in KD versus 96.73 ± 12.532 ng.L = 0.032). significant lower levels of serum cortisol levels were noted KD group than in FP group at 6 and 12 h after aortic unclamping < 0.001. As regard tracheal extubation time, patients assigned to KD group extubated earlier than whom in FP group 202.22 ± 28.674 versus 304.67 ± 40.598 min respectively < 0.001.
The use of KD during on-pump CABG confers better myocardial protective and anti-inflammatory effect than fentanyl propofol.
在冠状动脉手术期间，缺血再灌注导致的心肌损伤仍然不可避免。麻醉药物具有心肌预处理作用。氯胺酮具有拟交感神经作用，而右美托咪定除了具有麻醉、镇痛和抗炎特性外，还具有抗交感神经作用。本研究旨在比较氯胺酮 - 右美托咪定（KD）组合与芬太尼 - 丙泊酚（FP）组合对心肌肌钙蛋白T（cTnT）释放及冠状动脉旁路移植术后结局的影响。
90例接受冠状动脉旁路移植术（CABG）的成年患者被分配接受KD基础麻醉（KD组）或FP麻醉（FP组）。术后24小时内监测高敏cTnT、肌酸激酶同工酶（CK - MB）和血清皮质醇的变化趋势。其他结局指标包括生命体征、体外循环脱机情况、气管拔管时间和超声心动图检查结果。
在主动脉阻断松开后6小时的峰值时，KD组cTnT的释放显著低于FP组（KD组为92.01±7.332，FP组为96.73±12.532 ng/L，P = 0.032）。在主动脉阻断松开后6小时和12小时时，KD组血清皮质醇水平显著低于FP组（P < 0.001）。关于气管拔管时间，分配到KD组的患者拔管时间早于FP组，分别为202.22±28.674分钟和304.67±40.598分钟（P < 0.001）。
在体外循环冠状动脉旁路移植术中使用KD比芬太尼 - 丙泊酚具有更好的心肌保护和抗炎作用。
