右美托咪定预注对瓣膜置换术患者麻醉诱导期血流动力学和脑电双频指数的影响  

Effects of dexmedetomidine pretreatment on haemodynamics and bispectral index during anesthetic induction in patients undergoing cardiac valve replacement surgery with cardiopulmonary bypass

作　　者：王瑞雯[1] 高成杰[1] 王惠霞[1] 吕晓明[1] 姜冠华[2] 

机构地区：[1]解放军济南军区总医院麻醉科,250031 [2]解放军济南军区总医院心外科

出　　处：《国际麻醉学与复苏杂志》2013年第11期970-973,981,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的观察新型肾上腺素受体激动剂右美托咪定（dexmedetomi（iine，Dex）预注对瓣膜置换术患者麻醉诱导期血流动力学和脑电双频指数（bispectralindex，BIS）值的影响。方法选择择期瓣膜置换术患者30例，采用随机数字表法分为两组：Dex组（D组）和对照组（C组），每组15例。D组于麻醉诱导前静脉微量泵预注用生理盐水稀释成50ml的Dex（浓度为4mg／L）0．5μg／kg，输注时间为10min，C组以同样方式输注等体积生理盐水。均以依托咪脂、芬太尼、哌库溴铵、咪达唑仑复合诱导麻醉。记录入室后输注Dex前即刻基础值（T1）、输注Dex后5min（T2）、输注Dex后10min麻醉诱导前时刻（T3）、麻醉诱导后1min（T4）、麻醉诱导后3min（T5）、插管前OPN（T6）、插管即刻（T7）、插管后1min（T8）、插管后3min（Tq）、插管后5min（T10）各时点的心率（heartrate，HR）、有创血压值（artefial blood pressure，ABP）[收缩压（systolic blood pressure，SBP）、舒张压（diastolic blood pressure，DBP）、平均动脉压mean artery pressure，MAP）]和BIS变化。结果全麻诱导前，与T1（92．6±2．5）比较，D组BIS在T2（73．2±1．9）、T3（70．1±2．3）时显著下降（P〈0．05或P〈0．01），C组没有明显变化；全麻诱导期，与T3比较，两组BIS明显下降；气管插管期间，与T6比较，C组在T7时BIS（34．8±2．2）显著增高（P〈0．05或P〈0．01），而D组BIS无明显变化。与C组比较，D组BIS在T2～T5、T7明显降低（P〈0．05或P〈0．01）。全麻诱导前，与T1比较，D组在T2、T3时ABP略有增高，HR显著降低（P〈0．05或P〈0．01）；全麻诱导期，与T1比较，两组ABP、HR均下降；气管插管期间，与T6比较，D组DBP、MAP、HR在T7、T8略有升高，T9、T10无明显变化（P〉0．05），C组ABP、HR在B～T10显著增高（P〈0．05或P〈0．01）。与C组比较，D组SBP、MAP在T4-T10和DBP在T3-T10�Objective To evaluate the influence of dexmedetomidine（Dex）（highly selective α2-adrenergic receptor agonist） on haemodynamics and bispectral index （BIS） during anesthetic induction in patients undergoing valve replacement surgery. Methods Thirty NYHA class II or III patients, aged between 30 y and 70 y, undergoing cardiac value replacement with cardiopulmonary bypass, were randomly divided into two groups （n=15）： Dex group（group D） and control group（group C ）. In group Dex, pump diluted with saline to 50 ml of Dex （4 mg/L）0.5 μg/kg was administered iv 10 rain before the induction of anesthesia, while in group C, same volume of 0.9% normal saline was given. The patients were premedicated with intramuscular morphine and scopolamine. Anesthesia was induced with 0.06 mg/kg, fentanyl 6 μG/kg, etomidate 0.3 mg/kg and pipecuronium 0.10 mg/kg. Anesthesia was maintained with midazolam, fentanyl, intermittently. In two group, heart rate（HR）, arterial blood pressure（ABP） [ systolic blood pressure（SBP）, diastolic blood pressure（DBP）, mean arterial pressure（MAP）] and bispectral index（BIS） were recorded at the time before Dex infusion（T1）, 5 min after loading dose（T2）, 10 min after loading dose（T3）, 1,3 min after anesthesia induction（T4,Ts）, just before endotracheal intubation（T6）, endotracheal intubation（T7） and 1,3,5 min after endotracheal intubation（T8-10）. Results BIS of T2,T5 in group D was decreased significantly [from（92.6±2.5） to （73.2±1.9） and （70.1±2.3）]（P〈0.05 or P〈0.01） compared with TI. During anesthesia induction eompared with T3, BIS in both groups were decreased signifieantly. During endotracheal intubation compared with T6, BIS of T7 （34.8±2.2） was increased significantly in group C（P〈0.05 or P〈0.01 ）, while BIS in group C were similar to the initial values. Compared with group C, BIS decreased significantly at time T2-5,T7 in group D （P〈0.05 or P〈0.01 ）. Before anesthesia induction

关 键 词：右美托咪定 瓣膜置换 脑电双频指数 应激反应 血流动力学 

分 类 号：R614[医药卫生—麻醉学]