| Background:Coronary artery bypass grafting is internationally recognized as the most effective way of the treatment of coronary heart disease in the cardiovascular surgery.It has more than 30 years of history. The patients of coronary artery bypass grafting have poor cardiopulmonary function and instability circulatory. In order to ensure the supply of oxygen to maintain normal gas exchange, the postoperative patients usually reserved for endotracheal intubation and mechanical ventilation. So patients need sedation and paregoric to facilitate assisted ventilation and control stress response.The sedation and analgesia in the patients of coronary artery bypass grafting treatment is the basis for comprehensive treatment in the intensive care unit(ICU).Patients after coronary artery bypass have different degrees of agitation and pain, thereby affecting the respiratory function.The patients who are given sedative and analgesic can improve the respiratory status,lower body oxygen consumption, and stable hemodynamics. Patients who used sedative and paregoric after coronary artery bypass grafting can improve the tolerance of mechanical ventilation, improve the respiratory status is conducive to the recovery of heart and lung function, to avoid adverse consequences caused by postoperative agitation to accelerate the rehabilitation of patients.Dexmedetomidine is the U.S. Food and Drug Administration (FDA) 1999 ratified a new highly selective a2 adrenergic receptor agonist, DxM has the dose-dependent sedation, analgesia and anxiolytic effects, can be used for adults within 24 h of short-term sedation. China formally approved the Dexmedetomidine to be used for clinical application in July 2009. In this study, the Dexmedetomidine is used as sedation for the patients of coronary artery bypass grafting in the cardiac surgery ICU. The sedation effect of DxM compared with propofol, it provide a basis for clinical use.Objective:To study the effects of Dexmedetomidine for the sedation of the patients after coronary artery bypass grafting in the intensive care unit. Methods:The selective sixty coronary artery bypass grafting patients, aged 50 to 70 years old, male or female, randomly divided into 2 groups (n=30,each):control group (A group) and Dexmedetomidine group (B group). Group B patients in the ICU were used of the Dexmedetomidine as sedative,1.0 ug/kg Dexmedetomidine infusion for 10 minutes, followed by 0.2-0.7 ug/kg/h to maintain sedation, A group patients were used of the propofol as sedative in the ICU. Two groups of patients stoped using drug when they were fit off-line and extubation. Record the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP)of the two groups of patients before treatment 0h, after treatment 1h,2h,3h,4h,5h,6h, and extubation time(Eh). After recovery, patients were under the Steward awakening score table score, each score the two groups of patients, postoperative mechanical ventilation and extubation time, and emergence and extubation phases at different times after the dose of morphine, and the number of cases of adverse reactions.Results:The patients in the sex ratio, age, height, weight, no significant difference (P> 0.05). Extubation in the two groups, A group of patients with heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) was significantly higher compared with before treatment (P<0.05), while the B group of patients with heart rate (HR) no significant changes (P> 0.05), and A group of patients with blood pressure, heart rate was significantly higher than B group patients (P<0.05). A wake scores were lower than B group (P<0.05), two groups of patients with mechanical ventilation time was 10±0.6h (A group) and 7.0±0.7h (B group), extubation time was 16.6±0.5h (A) and 7.5±0.5h (B group) (P<0.05). B patients and extubation in the six stage after recovery time period,the doses of morphine was significantly less than the A group (P<0.05). B group patients with adverse reactions was lower than A group.Conclusion:Dexmedetomidine benefits the patients after coronary artery bypass surgery in the cardiac surgery ICU for the good sedative effect, recovery of good quality, effective stable hemodynamics, has low incidence of side effects such as nausea, back to sleep, restlessness, has a good safety.
|
PDF Full Text Request