右美托咪定对开胸手术患者围术期末梢灌注指数和心率变异性的影响  

Effects of dexmedetomidine on perioperative tip perfusion index and heart rate variability in patients undergoing thoracic surgery

作　　者：吴德华[1] 陆学芬 吴东进[1] 吴镜湘[1] 张晓峰[1] 曹晖[1] 沈耀峰[1] 徐美英[1] 

机构地区：[1]200030上海交通大学附属胸科医院麻醉科 [2]江苏省昆山市第一人民医院麻醉科

出　　处：《中华麻醉学杂志》2013年第9期1044-1046,共3页Chinese Journal of Anesthesiology

基　　金：上海市级医院适宜技术联合开发推广应用项目（SHDC12010222）

摘　　要：目的 探讨右美托咪定对开胸手术患者围术期末梢灌注指数（TPI）和心率变异性（HRV）的影响.方法 择期行肺癌根治术患者30例,ASA分级Ⅰ级或Ⅱ级,年龄40 ～ 70岁,体重38～80 kg,采用随机数字表法,将其分为2组（n=15）：对照组（C组）和右美托咪定组（D组）.C组静脉注射生理盐水20 ml,D组静脉注射右美托咪定1μg/kg（20 ml）.麻醉诱导：TCI异丙酚,血浆靶浓度4μg/ml,静脉注射芬太尼5 μg/kg（C组）或3 μg/kg（D组）和罗库溴铵0.9 mg/kg.气管插管后行机械通气,维持PETCO2 35～ 45 mm Hg.麻醉维持：D组TCI异丙酚,血浆靶浓度4 μg/ml,静脉输注右美托咪定0.5 μg·kg-1 ·h-1,必要时静脉注射芬太尼0.1 mg;C组TCI异丙酚,血浆靶浓度4 μg/ml,间断静脉注射芬太尼0.1 mg.分别于麻醉诱导前（T0）、气管插管前即刻（T1）、气管插管后即刻（T2）、切皮即刻（T3）、胸骨撑开即刻（T4）、开胸后30 min（T5）、1 h（T6）和术毕（T7）时,记录TPI、低频功率（LF）和高频功率（HF）,计算LF与HF的比值（LF/HF）.记录心血管事件的发生情况.结果 与C组比较,D组B-7时TPI值升高,T4-6时LF/HF降低,高血压发生率降低（P＜0.05）.结论 右美托咪定可通过降低交感神经张力,改善开胸手术患者微循环.Objective To investigate the effects of dexmedetomidine on perioperative tip perfusion index （TPI） and heart rate variability （HRV） in patients undergoing thoracic surgery.Methods Thirty ASA physical status Ⅰ or Ⅱ patients,aged 40-70 yr,weighing 38-80 kg,scheduled for elective radical operations for lung cancer,were randomly divided into 2 groups （n =15 each）：control group （group C） and dexmedetomidine group （group D）.Normal saline 20 ml was injected intravenously in group C,while dexmedetodine 1 μg/kg （20 ml） was injected intravenously in group D.Anesthesia was induced with target-controlled infusion （TCI） of propofol with the target plasma concentration （Cp） of 4 μg/ml,and iv injection of fentanyl 5 μg/kg （in group C） or 3 μg/kg （in group D） and rocuronium 0.9 mg/kg.When BIS value decreased to 50,a double lumen endobronchial tube was inserted.The patients were mechanically ventilated and PETCO2 was maintained at 35-45 mm Hg.Anesthesia was maintained with TCI of propofol with the Cp of 4 μg/ml,infusion of dexmedetodine 0.5 μg· kg-1 · h-1,and injection of fentanyl 0.1 mg when needed in group D,or with TCI of propofol with the Cp of 4μg/ml and intermittent iv boluses of fentanyl 0.1 mg in group C.Before induction （T0）,immediately before and after intubation （T1,2）,immediately after skin incision （T3）,immediately after splitting of sternum （T4）,at 30 min and 1 h after chest opening （T5,6）,and at the end of operation （T7）,TPI,low frequency power （LF） and high frequency power （HF）were recorded,and LF/HF ratio was calculated.The development of cardiovascular events was recorded.Results Compared with group C,TPI at T3-7 was significantly increased,LF/HF ratio at T4-6 was decreased,and the incidence of hypertension was decreased in group D （P 〈 0.05）.Conclusion Dexmedetomidine can improve microcirculation through decreasing sympathetic activity in patients undergoing thoracic surgery. Keywords：Dexmedetomidine; Plethysmography

关 键 词：右美托咪啶 体积描记术 心率 

分 类 号：R614[医药卫生—麻醉学]