Clinical Application Of Small Dose Of Dexmedetomidine In Off-pump Coronary Artery Bypass Grafting

Objective:Through continuous low dose infusion of dexmedetomidine observation peri operation period(Dexmedetomidine, DEX) in off-pump coronary artery bypass grafting(off-pump coronary artery bypass grafting surgery, OPCABG) influence the outcome in patients with hemodynamic indexes in the body and after surgery, to investigate the effects of dexmedetomidine on the efficacy and safety of OPCABG confining perioperative application.Methods:In 60 cases under general anesthesia for patients with OPCABG, not limited to sex, age 50 ~ 70 years old, ASA, grade II to III, cardiac function of grade II to III without mentalconsciousness, mental retardation, liver and kidney function and respiratory system with no obvious abnormality, no previous history of anesthetic drug allergy history. Were randomly divided into two groups: control group(group C) and dexmedetomidine group(D group), 30 cases in each group. Group D patients after intravenous infusion of burglary, improve the monitoring of Dex 0.2ug/kg10 min, pump injection is completed, followed by 0.4 ug/kg/h until extubation, C of physiological saline group was given equal dose.1. Record before anesthesia patients generally(gender, age, height, body mass index, ASA sizing); 2.Recordings of several hemodynamic variable were made preoperativel(T0),after 10 min infusion(T1),end of induction(T2),sternotomy(T3),at anastomosis of left anterior descending(T4),at anastomosis of left circumflex coronary artery or diagonal artery(T5),at anastomosis of right coronary artery or posterior descending artery(T6),at 15 min after reestablishment of coronary blood flow(T7),end of operation(T8),6h after operation(T9) and after tracheal extubation(T10)time points after the heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP), mean arterial pressure(MAP), mean pulmonary artery pressure(MPAP), central venous pressure(CVP), pulmonary capillary wedge pressure(PCWP), cardiac output(CO), and calculate the cardiac index(CI), systemic resistance index(SVRI), and pulmonary circulation resistance index(PVRI), and(TO) before operation, postoperative 12 hours(T11) and postoperative 24 hours(T12) via vein blood 3 ml, specimen after checkout room monitoring biochemical indexes.3 Records of patients in two groups andpostoperative propofol, sufentanil, vasoactive drugs; 4 Record the operation time of two groups of patients, postoperative mechanical ventilation time, extubation time, ICU stay time, hospitalization time;5 Record two groups of patients.The occurrence of perioperative adverse events.Results:1. compare with T0, T1 two groups HR and MAP did not change significantly, compared with the c group d T1-T9 BIS reduced(P<0.05). Group T2, T3 and T10 and d c HR and MAP increased significantly(P<0.05), T4-T8 MAP reduced the difference was statistically significant. 2. compared with c group d, peri-reduced dosage sufentanil and propofol dosage reduced, reduced the amount of norepinephrine(P<0.05) 3. compared with the c group d after surgery 12-hour and 24-hour urine after surgery(P<0.05) Cr, BUN has reduced but no statistically significant difference(P>0.05) compared with c group, DEX group after 12 hours and 24 hours after surgery LAC decreased, there was a statistically significant difference(P<0.05) Group d after 12 hours and 24 hours postoperatively LAC a preoperative decreased(P<0.05) 4. compared with the c group d perioperative adverse events hypertension, reduce the incidence of delirium, agitation, chills(P<0.05) 5. group compared with the c group d in patients with postoperative duration of mechanical ventilation and ICU stay, length of stay decreased, the difference was statistically significant(P<0.05)Conclusion:Intravenous loading dose of dexmedetomidine 0.2ug/kg followed by 0.4ug/kg/h to maintain theinfusion, can produce significant sedative effect, reducing stress reflection, maintain the stability of hemodynamics at the same time does not cause hypotension and obvious Heartbeat bradycardia, and can reduce the perioperative adverse events, shorten the days of hospitalization after operation.