Effects Of Dexmedetomidine On Hemodynamics And Renal Function In Patients Undergoing Off-pump Coronary Artery Bypass Grafting

Objective To investigate the effects of dexmedetomidine on hemodynamics and acute kidney injury(AKI)in patients undergoing off-pump coronary artery bypass grafting(OPCABG).Methods A total of 125 ASA II or ? grade patients,aged 55~74 years old,scheduled for elective off-pump coronary artery bypass grafting were randomly allocated to dexmedetomedine group(D)and control group(C).63 patients in the group D received intravenous infusion of 0.6 ?g/kg dexmedetomidine followed by 0.4 ?g·kg-1·h-1 continuous infusion until the end of surgery and 62 patients in the group C received an equal volume of saline infusion for 15 minutes before anesthesia induction,Anesthesia induction with midazolam 0.02 mg / kg,propofol target controlled infusion(TCI)was started to provide an effect-site concentration of 1.0 ?g /ml,and increased by 0.3?g/ml every 1 min until loss of consciousness(LOC),followed by sufentanil 0.8~1.0 ?g/kg,rocuronium 0.6~0.9 mg/kg.The age,gender,BSA,preoperative medication,preoperative complications and other Preoperative demographic and clinical data of the patients were recorded,as well as the duration of operation and anesthesia,extubation time,length of ICU stay and postoperative hospital,volume of intraoperative and autologous blood transfusion,dosage of vasoactive drugs and other medicatons.The following 11 time points were observed: baseline(T0),pre-intubation(T1),after endotracheal intubation for 1 minute(T2),after endotracheal intubation for 5 minutes(T3),after skin incision(T4),after sternotomy(T5),descending branch of left circumflex artery bypass grafting(T6),anastomosis Clamp(T7),right coronary artery bypass grafting(T8),close the chest(T9)the end of surgery(T10).Heart rate(HR),mean arterial pressure(MAP)and BIS value at corresponding time point were recorded.Creatinine and urea nitrogen,glomerular filtration rate and urine output were also recorded at preoperative and postoperative 1,2,3 days.Result The preoperative demographic and clinical data of the patients including age,gender,BSA,LA,LVD,EF value,preoperative medication,preoperative complications were no significant difference between the two groups(P > 0.05).Compared with group C,HR in group D was lower(P <0.05)during surgery,and mean arterial pressure in both groups was not statistically significant(P > 0.05).Accroding to AKIN,AKI develop in 3 of patients in group D and 12 of patients in Group C.(P = 0.012).Compared with group C,group D had more urine output than group C(P <0.05),the dosage of norepinephrine and propofol were less than group C(P <0.05),and the dosage of nitroglycerin was more than group C(P <0.05),the difference was statistically significant(P <0.05).Mechanical ventilation time,ICU stay time and postoperative hospital stay were obviously shorter than group C and recovery time longer than group C(P <0.05).Conclusion Our study demonstrated that dexmedetomidine after off-pump coronary artery bypass grafting is associated with a significant decrease HR,and maintain hemodynamic stability.reduce the dosage of vasoactive drugs and increased intraoperative urine output.and it can decrease the incidence of AKI.Moreover,it has a positive impact on the outcome by shortening ICU stay and the hospitalization days.