Objective To explore the effects of dexmedetomidine in patients undergoing coronary artery bypass grafting surgery.Methods One hundred and fifty patients scheduled for elective CABG in Henan Provincial People′s Hospital from February 2013 to March 2014, were randomly divided into 3 groups ( n =50 ):dexmedetomidine group ( group D), propofol group ( group P) and control group ( group C).After induction of anesthesia,patients in group D,dexmedetomidine was given by intravenous infusion at the rate of 0.5 μg・ kg-1・h-1 and in group P,propofol was infused by intravenous at the speed of 5 mg・ kg-1・ h-1 till the end of operation, while in group C the same volume normal saline was given .Changes of mean artery pressure (MAP),pulmonary artery wedge pressure (PCWP),central venous pressure ( CVP),cardiac outcome ( CO) and changes of cardiac troponinI(cTnI) and creatine kinase ( CK)-MB were monitored during the period of peri-operative ( period). Mechanical ventilation time, intensive care unit ( ICU) and hospital stay length were recorded.The adverse cardiovascular events(such as the perioperative arrhythmic,myocardial infarction,and cardiac arrest)were recorded and compared among the three groups.The Ramssay score system was used to evaluate the sedative effect . Results There was no significant difference in the patients ′data among the three groups,including gender,age, body weight,ASA grade,ejection fraction before surgery, duration of anesthesia,CPB and surgery.The cardiac output in group D and P were much higher than that in control group at the end of the surgery and all the time points after surgery.Compared to the group P,the cardiac output in group D was much higher (P <0.05).The plasma cTnI and CK-MB concentration was significantly lower at the end of operation ,6 h,24 h and 48 h after operation in group D and P than in group C ( P <0.05 ).There were significant differences in postoperative mechanical ventilation time,ICU and hospital stay in group D and P than in group C (P <0.05).Perioperative arrhythmia,the incidence of myocardial infarction and cardiac mortality were lower than group C and group P ,the difference had statistical significance (P <0.05).Conclusion Dexmedetomidine preconditioning improves cardiac function and reduce the incidence of complications in patients undergoing coronary artery bypass grafting surgery . Dexmedetomidine has better myocardial protective effect than propofol .%目的探讨右美托咪定对冠状动脉旁路移植术患者的心肌保护作用。方法选择河南省人民医院2013年2月至2014年3月择期冠状动脉旁路移植术患者150例，随机分为3组：对照组（C 组）、右美托咪定组（D 组）和丙泊酚组（P 组）。麻醉诱导后 D 组静脉输注右美托咪定0.5μg・ kg-1・ h-1、C 组以相同速率静脉输注等容量生理盐水、P 组静脉输注丙泊酚5 mg・ kg-1・ h-1至术毕。分别检测三组术中和术后48 h 内不同时点心肌肌钙蛋白 I（cTnI）浓度及肌酸激酶同工酶（CK-MB）活性变化以及心率、平均动脉压、肺毛细血管楔压和心输出量（CO）等血流动力学指标的变化。同时记录机械通气时间、ICU 滞留时间和住院时间。比较三组患者围术期心律失常的发生率、心肌梗死的发生率和心源性死亡率。采用 Ramsay 镇静评分评价三组患者的镇静效果。结果三组患者之间的性别、年龄、体质量、ASA 分级、术前射血分数和搭桥根数无统计学差异（P ＞0.05），麻醉时间、体外循环时间、外科手术时间无统计学差异（P ＞0.05），术后镇静效果相同。与对照组相比，D 组、P 组 CO 在手术结束时及术后各时点都较手术前开始显著提高，但 D 组 CO升高更明显，与 P 组相比，差异有统计学意义（P ＜0.05）。与对照组相比，D 组、P 组在术毕、术后6 h、术后24 h 和术后48 h 血中 cTnI 浓度、CK-MB 活性均降低，差异有统计学意义（P ＜0.05）；D 组与 P 组相比，差异无统计学意义（P ＞0.05）。 D 组、P 组的机械通气时间、ICU 滞留时间和住院时间明显低于对照组，差异有统计学意义（P ＜0.05）。 D 组患者围术期心律失常的发生率、心肌梗死的发生率和心源性死亡率低于 P 组，差异有统计学意义（P ＜0.05）。结论冠状动脉旁路移植术患者，采用右美托咪定预处理能改善心脏功能，减少心脏并发症；右美托咪定的心肌保护作用优于丙泊酚。
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