Objective To investigate the influence of dexmedetomidine on hemodynamics during off pump coronary artery bypass grafting under sevoflurane anesthesia.Methods Totally 60 patients who underwent off pump coronary artery bypass grafting under sevoflurane anesthesia from April 2014 and April 2015 were randomly divided into dexmedetomidine group and control group.The heart rate,mean arterial pressure (MAP),cardiac output (CO) during operation were monitored after radial artery puncture (T0),after tracheal intubation (T1),when sternum being opened (T2),when grafting with left anterior descending branch (T3),when grafting with posterior descending coronary artery (PDA) (T4) and at the end of operation (T5).The intraoperative blood transfusion volume,blood loss and urine volume and the hypotension at T4 were observed and compared between the two groups.Results Sex,age,height,body mass,anesthesia time,operation time,intraoperative blood transfusion volume,intraoperative blood loss,intraoperative urine output showed no significant difference between the two groups (P ＞ 0.05).At T0 time point,there was no significant difference of MAP and heart rate between the two groups (P ＞ 0.05).At time points of T0 to T5,CO showed no significant difference between the two groups (P ＞ 0.05);at T1,T2,T4,T5,the MAP and heart rate in dexmedetomidine group were significantly lower than those in control group [MAP:(72 ± 11) mmHg vs (78±11) mmHg,(76 ±9) mmHg vs (82 ±12) mmHg,(65±8) mmHg vs (68 ±10) mmHg,(71 ± 12) mmHg vs (76 ± 10) mmHg;heart rate:(68 ± 13) times/min vs (74 ± 14) timesmin,(72 ± 10) times/min vs (76 ± 11) times/min,(69 ± 12) times/min vs (78 ± 13) times/min,(66 ± 12) times/min vs (73 ± 11) times/min] (P ＜ 0.05).At T4,hypotension occurred in 8 cases (26.7％) in control group and 7 cases (23.3％) in dexmedetomidine group,showing no significant differences between the two groups (P ＞ 0.05).Conclusion Intraoperative continuous infusion of dexmedetomidine can reduce the stress response,moderately reduce mean arterial pressure and slow the heart rate,while not reduce the cardiac output,being applicable in anesthesia during off-pump coronary artery bypass surgery.%目的 探讨右美托咪定对七氟烷麻醉下不停跳冠状动脉旁路移植术的血流动力学影响.方法 选取2014年4月至2015年4月择期行不停跳冠状动脉旁路移植术患者60例,完全随机分为右美托咪定组和对照组,各30例,术中用Flotrac/Vigileo监测2组患者心率、平均动脉压(MAP)、心排血量.记录以下各时点相关数据:桡动脉穿刺完毕(T0),气管插管完毕(T1),劈开胸骨(T2),搭前降支(T3),头低位搭后降支(T4),术毕(T5).比较2组患者术中输液量、术中出血量、术中尿量和T4时点低血压的例数.结果 2组患者性别构成、年龄、身高、体质量、麻醉时间、手术时间、术中输液量、术中出血量、术中尿量比较,差异均无统计学意义(均P ＞0.05).T0时点,2组MAP、心率比较,差异无统计学意义(P ＞0.05);T0 ～T5时点,2组心排血量比较,差异均无统计学意义(P＞0.05).T1、T2、T4、T5时点,右美托咪定组MAP、心率均低于对照组[MAP:(72±11) mmHg(1 mmHg=0.133 kPa)比(78 ± 11) mmHg、(76 ±9)mmHg比(82±12) mmHg、(65±8) mmHg比(68±10)nmmHg、(71±12)mmHg比(76±10) mmHg;心率:(68±13)次/min比(74±14)次/min、(72±10)次/min比(76±11)次/min、(69±12)次min比(78±13)次/min、(66±12)次/min比(73±11)次/min],差异有统计学意义(P＜0.05).T4时点对照组有8例(26.7％)低血压,右美托咪定组有7例(23.3％)低血压,2组比较差异无统计学意义(P＞0.05).结论 术中持续泵注右美托咪定能降低应激反应,适度降低MAP、减慢心率,不降低心排血量,适用于不停跳冠状动脉旁路移植术麻醉.
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