目的 评价右美托咪定（dexmedetomidine, Dex）对CPB冠状动脉旁路移植术（coronary artery bypass grafting, CABG）患者左心室内同步化的影响。 方法 择期CPB下行CABG患者21例，年龄45~74 岁，身高151~176 cm，体重52~85 kg，ASA分级Ⅱ、Ⅲ级，纽约心脏病协会（New York Heart Association, NYHA）分级2级或3级。采用随机数字表法分为两组：实验组（D组，10例），对照组（C组，11例）。D组在停CPB 15 min后泵注0.5 μg/kg Dex，10 min输注完，继以0.5 μg·kg-1·h-1维持至术毕；C组以相同速率静脉泵注等容量生理盐水。于锯胸骨前（T0）、停止CPB后15 min泵注Dex前（T1）、泵注Dex 30 min（T2）、泵注Dex 1 h（T3）时分别记录MAP、HR、CVP、肺动脉阻塞压（pulmonary artery occlusion pressure, PAOP）和经食管超声心动图（transesophageal echocardiography, TEE）监测指标：左室射血分数（left ventricular ejection fraction, LVEF）、心排血量（cardiac output, CO）、每搏量（stroke volume, SV）、左室17节段整体纵向应变收缩期达峰时间的标准差（standard deviation of time to maximum systolic velocity of the 17 left ventricular segments of longitudinal strain, Tssl-17-SD）、左室16节段环向应变收缩期达峰时间的标准差（standard deviation of time to maximum systolic velocity of the 16 left ventricular segments of circumferential strain, Tssc-16-SD）。 结果 D组HR在T2［（71.0±5.4） 次/min］、T3［（69.3±2.8） 次/min］时较C组［（89.5±14.7）、（89.4±14.0） 次/min］低（P<0.05）；D组CO在T2［（4.4±1.2） L/min］时低于C组［（5.8±1.5） L/min］（P<0.05）。D组Tssl-17-SD在T2时较C组明显升高（P<0.01）。 结论 CPB后泵注Dex早期能抑制CABG患者左心室心肌纵向的同步化运动。
Ｏｂｊｅｃｔｉｖｅ This study was designed to investigate the role of dexmedetomidin(Dex) on left ventricular synchronization in patients undergoing coronary artery bypass grafting(CABG) with CPB. Methods Twenty-one patients were selected using a random number table. These patients were classified as New York Heart Association(NYHA) class Ⅱ,Ⅲ and ASA physical statusⅡ,Ⅲ with age of 45-74 y and weight of 52-85 kg. They were further divided into Dex group(group D, n=10) and control group(group C, n=11). After stopping CPB for 15 min, a loading dose of Dex at 0.5 μg/kg was injected intravenously 10 min after stopping CPB for 15 min followed by infusion at 0.5 μg·kg-1·h-1 until the end of operation in group D, while equal volume of normal saline was given in group C. At the time of before sternotomy(T0), stopping CPB for 15 min(T1), injection of Dex for 30 min(T2) and for 1 h(T3), the MAP, HR, CVP, pulmonary artery occlusion pressure(PAOP) and transesophageal echocardiography(TEE) monitoring indicators including left ventricular ejection fraction (LVEF) and cardiac output(CO), stroke volume(SV), standard deviation of time to maximum systolic velocity of the 17 left ventricular segments of longitudinal strain(Tssl-17-SD) and standard deviation of time to maximum systolic velocity of the 16 left ventricular segments of circumferential strain(Tssc-16-SD) were recorded. Results The HR were statistically lower in group D[(71.0±5.4), (69.3±2.8) bpm] than those in group C[(89.5±14.7), (89.4±14.0) bpm] at T2, T3 (P<0.05). CO in group D[(4.4±1.2) L/min] was statistically lower than that in group C[(5.8±1.5) L/min] at T2(P<0.05). Compared with group C, Tssl-17-SD was statistically increased at T2 in group D(P<0.01). Conclusions In patients undergoing CABG with CPB, the injection of Dex after CPB may inhibit the synchronized movement of the left ventricular longitudinal strain.
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