右美托咪定对心脏瓣膜置换术患者麻醉诱导期血流动力学的影响

摘要

Objective To observe the effect of dexmedetomidine on hemodynamics of patients with cardiac valve replacement operation during anesthesia induction period .Methods Fifty patients with cardiac valve replacement opera-tion (ASA Ⅱ-Ⅲ, NYHA Ⅱ-Ⅲ, aged 40-63, weight 50-75 kg) were randomly divided into experimental group (Group Dex) and control group (Group C).Equivalent dexmedetomidine and 0.9%sodium chloride were pumped in 1.0 μg/kg in 10 min before anesthesia induction , following to the maintenance dose of 0.5 μg/kg until the end of surgery in Group Dex and Group C, respectively.Endotracheal intubation was performed when the BIS was between 55-65.Anes-thesia was maintained by using propofol and fentanyl .The systolic blood pressures (SBPs), diastolic blood pressures (DBPs), mean arterial pressures (MAPs), heart rate (HRs) and blood pressures changes before dosing (T1), 10 min after dosing (T2), immediate intubation (T3), 1 min after intubation (T4), 5 min after intubation (T5), and 10 min after intubation (T6) were recorded.Results The HRs in Group Dex were significantly lower at T2, 3, 4, 5 and 6 than that at T1 (P＜0.05).The HRs in Group Dex were significantly lower than those in Group C at T 2, 3 and 4 (P＜0.05).The SBPs in Group C were significantly lower at T5 and 6 than that at T1 (P＜0.05).The SBPs and MAPs were in both two groups at T5 and 6 were significantly lower that those at T2 (P＜0.05).The low heart rate incidences in Group Dex was significantly lower than that in Group C (P＜0.05), though there was no significant difference in blood pressure increased or decreased incidences between the two groups .Conclusion Dexmedetomidine will slow heart rate and maintain hemodynamic stability in anesthesia induction for patients with cardiac valve replacement operation .That will help reduce the risk of myocardial ischemia and arrhythmia for patients with cardiac valve replacement .%目的 观察右美托咪定对心脏瓣膜置换术患者麻醉诱导期血流动力学的影响.方法 择期行心脏瓣膜置换术患者50例,ASAⅡ～Ⅲ级,NYHAⅡ～Ⅲ级,年龄40～63岁,体重50～75 kg,随机双盲分为两组:右美托咪定组(Dex组)和对照组(C组). Dex组患者于麻醉诱导前10 min静脉泵注右美托咪定1.0 μg/kg,维持剂量0.5 μg/(kg·h)直至手术结束;C组患者泵注相同容积的生理盐水.患者在诱导期间心率低于50次/min时可给予阿托品0.5 mg,血压低于70/40 mmHg时停止给药,可酌情给予麻黄碱提升血压,必要时可重复给药.两组麻醉诱导方法相同,维持脑电双频指数(BIS)值在55～65 时行气管插管,术中采用复合丙泊酚和瑞芬太尼.分别在给药前(T1)、给药后10 min(T2)、插管即刻(T3)、插管后1 min(T4)、插管后5 min (T5)、插管后10 min(T6)记录收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),观察并记录麻醉诱导期血压、心率变化.结果 (1)两组患者诱导期HR变化:Dex组T2～T6时HR均明显较T1时点减慢(P＜0.05);两组间同时点比较,Dex组T2、T3及T4心率明显低于C组(P＜0.05). (2)两组患者诱导期SBP、DBP、MAP变化:C组 T5、T6时点SBP明显低于T1时点(P＜0.05);两组T5、T6时点SBP、MAP明显低于T2时点(P＜0.05). (3)两组患者麻醉诱导期血压、心率变化情况:Dex组患者发生心率下降的例数明显多于C组(P＜0.05),而两组血压上升、血压下降例数比较差异无统计学意义(P＞0.05).结论 右美托咪定可减慢心脏瓣膜置换术患者心率,维持其麻醉诱导期血流动力学稳定,可能有利于降低心脏瓣膜置换术患者心肌缺血、心律失常的风险.