右美托咪定对快室率心房颤动患者行非心脏手术时麻醉诱导期血流动力学的影响  

Effects of dexmedetomidine on hemodynamics during induction of anesthesia in patients with atrial fibrillation with rapid ventricular rate undergoing noncardiac surgery

作　　者：薛智敏[1] 王世端[1] 刘爱杰[1] 栾海虹[1] 袁莉[1] 江岩[1] 

机构地区：[1]青岛大学附属医院麻醉科,266003

出　　处：《中华麻醉学杂志》2014年第12期1452-1454,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价右美托咪定对快室率心房颤动患者行非心脏手术时麻醉诱导期血流动力学的影响.方法 行择期手术的风湿性心脏瓣膜病并发快室率心房颤动患者50例,性别不限,年龄45-64岁,体重50 - 75kg,心室率≥90次/min,ASA分级Ⅱ或Ⅲ级,NYHA分级Ⅱ或Ⅲ级.采用随机数字表法,将其分为2组（n=25）：对照组（C组）和右美托咪定组（D组）.D组于常规麻醉诱导前10min静脉输注右美托咪定0.6 μg/kg.常规麻醉诱导：静脉注射咪达唑仑0.06 mg/kg、舒芬太尼0.6 μg/kg和维库溴铵0.12 mg/kg,当BIS值≤55时行气管插管.分别于入室后（T0）、右美托咪定输注停止后即刻（T1）、气管插管前即刻（T2）、气管插管后1、3、5 min（T3-5）时记录SP、DP、MAP及HR,同时记录麻醉,诱导至气管插管后5 min内心血管事件的发生情况.结果 与T0时比较,C组HR T2,5时降低,T3,4时升高,D组HR T1-5时降低;C组SP、DP及MAP T2,5时降低,T3时升高（P＜0.05或0.01）,D组上述指标差异无统计学意义（P＞0.05）;与C组比较,D组低血压、高血压和心动过速的发生率降低（P＜0.05）,心动过缓发生率差异无统计学意义（P＞0.05）.结论 静脉输注右美托咪定0.6μg/kg有助于维持快室率心房颤动患者行非心脏手术时麻醉诱导期血流动力学稳定.Objective To evaluate the effects of dexmedetomidine on hemodynamics during induction of anesthesia in the patients with atrial fibrillation with rapid ventricular rate undergoing noncardiac surgery.Methods Fifty patients with rheumatic valvular heart disease complicated with atrial fibrillation,aged 45-64 yr,weighing 50-75 kg,with ventricular rate ≥ 90 bpm,of ASA physical status Ⅱ or Ⅲll （NYHA Ⅱ or Ⅲ）,scheduled for elective surgery,were randomly divided into 2 groups （n =25 each） using a random number table：control group （group C） and dexmedetomidine group （group D）.Dexmedetomidine 0.6 μg/kg was infused intravenously at 10 min prior to induction of anesthesia in group D.Anesthesia was induced with iv midazolam 0.06 mg/kg,sufentanil 0.6 μg/kg,and vecuronium 0.12 mg/kg.Tracheal intubation was performed when the BIS value≤≤ 55After admission to operating room （T0,baseline）,immediately after the end of dexmedetomidine infusion （T1）,immediately before intubation （T2）,and at 1,3 and 5 min after intubation （T3-5）,SP,DP,MAP and HR were recorded.The adverse cardiovascular events were recorded starting from induction of anesthesia to 5 min after intubation.Results Compared with the baseline value at T0,HR was significantly decreased at T2,5,while increased at T3,4 in group C,and HR was decreased at T1-5 in group D; SP,DP and MAP were decreased at T2,5,while increased at T3 in group C,and no significant changes were found in the indices mentioned above in group D.Compared with group C,the incidence of hypotension,hypertension and tachycardia was significantly decreased,and no significant changes were found in theincidence of bradycardia in group D.Conclusion Dexmedetomidine 0.6 μg/kg infused intravously is helpful in maintaining the hemadynamics stable during induction of anesthesia in the patients with atrial fibrillation with rapid ventricular rate underging noncardiac surgery.

关 键 词：右美托咪啶 心房颤动 插管法 气管内 血流动力学 

分 类 号：R614[医药卫生—麻醉学]