目的 研究右美托咪定在不停跳冠脉搭桥术后低氧血症中的临床应用。
方法 对43例不停跳冠脉搭桥术后出现低氧血症的患者随机被分成对照组22人和实验组21人，对照组采用常规治疗，实验组采用常规治疗的基础上加上右美托咪定的治疗。分别记录治疗前、治疗后半小时、六小时的患者氧饱和度、心率、血压、呼吸频率、PaCO2、PaO2；观察ICU滞留时间及再次气管插管率。
结果 治疗前两组差异无统计学意义（P>0.05），治疗后半小时、六小时后实验组和对照组缺氧程度改善（P<0.05），再次插管率低于对照组（P<0.05），ICU滞留时间低于对照组（P<0.05）。
结论 右美托咪定可纠正非停跳冠脉搭桥后低氧血症，减少再次插管的几率，并可缩短ICU滞留时间。
Methods: Forty-three patients, who had off-pump coronary artery bypass graft (CABG) surgery, were randomly divided into two groups, control group(n=22) and experimental group(n=21). patients in both group accepted routine treatment. The experimental group was given the treatment of dexmedetomidine additionally. SaO2,HR,BP,RR,PaCO2、PaO2 were observed pre-treatment and 30min,6 hours after treatment. Duration of ICU stay and endotracheal re-intubation were also observed.
Results: The differences between two groups were not significantly initially. Compared with control group，SaO2, PaCO2、PaO2 improved, while the Hr and RR decreased after the therapy of dexmedetomidine 30min and 6 hours later. There were no changes of PaCO2. The incidence of endotracheal re-intubation was lower than the control group(P＜0.05). And the duration of ICU stay of experimental group was much shorter than the control group. The difference between the two groups was statistically significant(p＜0.05) .
Conclusion：Dexmedetomidine combined with routine treatment in postoperative hypoxemia after off-pump CABG could correct hypoxemia，And it could decrease incidence of endotracheal re-intubation and shorten duration of ICU stay.
[1]Huffmyer JL, Groves DS.Pulmonary complications of cardiopulmonary bypass[J].Best Pract Res Clin Anaesthesiol, 2015, 29(2):163-75
[2]Christenson JT, Aeberhard JM, Badel P, Pepcak F, Maurice J, Simonet F, VelebitV, Schmuziger M.Adult respiratory distress syndrome after cardiac surgery[J].Cardiovasc Surg, 1996, 4(1):15-21
[3]Nelson S, Muzyk AJ, Bucklin MH, Brudney S, Gagliardi JP.Defining the Role of Dexmedetomidine in the Prevention Best Practice & Research Clinical Anaesthesiology of Delirium in the Intensive Care Unit[J].[J].Biomed Res Int,, 2015, 2015(0):635-637
[4]Rodrigues RR, Sawada AY, Rouby JJ, Fukuda MJ, Neves FH, Carmona MJ, Pelosi P, Auler JO, Malbouisson LM.Computed tomography assessment of lung structure in patients undergoing cardiac surgery with cardiopulmonary bypass[J].Braz J Med Biol Res, 2011, 44(6):598-605
[5]Asimakopoulos G, Smith PL, Ratnatunga CP, Taylor KM.Lung injury and acute respiratory distress syndrome after cardiopulmonary bypass[J].[J].Ann Thorac Surg, 1999, 68(3):1107-1115
[6]陈德海, 王萍, 张申, 吴联合, 张培.非体外循环冠状动脉旁路移植术后呼吸功能衰竭的治疗[J].[J].中国胸心血管外科临床杂志, 2012, 19(1):90-92
[7]杜英杰; 王古岩.右美托咪定的心脏保护作用[J].[J].中国分子心脏病学杂志, 2012,12(5);313-316, 12(5):313-316
[8]养红, 张丽娜, 冯彩华, 董海龙.右美托咪啶与咪达唑仑对重症监护患者镇静作用的对比研究[J].[J].临床和实验医学杂志, 2013, 12(17):1388-1389
