右美托咪定对青年患者心率变异性的影响  

Effects of dexmedetomidine on heart rate variability of young patients

作　　者：钟毅[1,2] 殷永强 蒋柯[2] 徐世元[1] 

机构地区：[1]南方医科大学珠江医院麻醉科,广州市510515 [2]贵阳医学院附属医院麻醉科

出　　处：《临床麻醉学杂志》2015年第10期953-956,共4页Journal of Clinical Anesthesiology

基　　金：贵州省卫生厅科学技术基金(gzwkj2013-1-002)

摘　　要：目的观察右美托咪定对青年患者心率变异性（heart rate variability,HRV）及药物给予过程中自主神经张力和均衡性的影响。方法 36例择期手术的青年患者,男18例,女18例,年龄20~35岁,ASAⅠ级。按随机数字表分为三组,每组12例。所有临床观察均在早上8点至10点间进行,开放静脉通道,C组泵入生理盐水,D1组泵入右美托咪定1.0μg/kg负荷量,10min微量泵泵入,持续泵注量0.5μg·kg-1·h-1,持续时间50min;D2组泵入右美托咪定1.5μg/kg负荷量,10min微量泵泵入,持续泵注量0.75μg·kg-1·h-1,持续时间50min。分别于药物泵注前（T0）、右美托咪定静脉泵注后15~20min（T1）、45~50min（T2）通过数字化心电工作站监测给药过程中5min短时程HRV,HRV时域指标包括5min心搏总量、平均心室率、R-R间期值的标准差（SDNN）、相邻正常R-R间期差值的均方根（RMSSD）、相邻正常R-R间期差值≥50ms的心搏数占总R-R间期数的百分数（PNN50）及频域指标包括低频功率（LFnorm）、高频功率（HFnorm）和交感/迷走张力的平衡比值（LF/HF）的变化。结果与T0时比较,T1、T2时D1组和D2组5min心搏总量明显减少（P〈0.05）,平均心室率明显减慢（P〈0.05）,RMSSD明显延长,PNN50明显增加（P〈0.05）;T1时D1组HFnorm明显升高,LF/HF明显降低（P〈0.05）,T1、T2时D2组HFnorm明显升高（P〈0.05）,LFnorm、LF/HF明显降低（P〈0.05）。与T1时比较,T2时D2组的5min心搏总量明显增加,平均心室率明显增快（P〈0.05）。与C组比较,T1、T2时D1和D2组5min心搏总量明显减少,平均心室率明显减慢,RMSSD明显延长,PNN50明显增加（P〈0.05）;D2组的SDNN明显增加（P〈0.05）,HFnorm明显增快,LF/HF明显降低（P〈0.05）,T1时D1组LF/HF明显降低（P〈0.05）。结论右美托咪定给药过程中交感神经张力降低,迷走神经张力增高,交感与迷走神经张力平衡比值降低,1.5μg/kg负荷剂量的右美托咪定对自主神经的�Objective To investigate the effects of dexmedetomidine（Dex）on heart rate variability（HRV）of young patients,and the change of autonomic nervous system（ANS）tension and balance ability of ANS.Methods Thirty-six young patients undergoing elective surgery,male 18 cases,female 18 cases,aged 20-35 years,ASA Ⅰ grade,were randomly divided into three groups.Twelve young patients were pump injected Dex 1.0μg/kg loading dose,then continuously pumping Dex 0.5μg·kg-1·h-1（group D1）.Twelve other young patients were pump injected Dex 1.5μg/kg,then continuously pumping Dex 0.75μg·kg-1·h-1（group D2）.The control group（group C）were injected normal saline.The change of HRV time-domain index（5min total heart rates,the average ventricular rate,SDNN,RMSSM,PNN50）and frequency-domain index（LFnorm,HFnorm,LF/HF）were monitored by the workstation of digital ECG before pump injection of Dex（T0）,15-20 min after pump injection of dexmedetomidine（T1）,and 45-50 min after pump injection of dexmedetomidine（T2）.Results Compared with T0,5min total heart rates and the average ventricular rate were decreased at T1 and T2in two trial groups（P〈0.05）,RMSSD and PNN50 were significantly increased at T1 and T2（P〈0.05）.HFnorm were increased and LF/HF were decreased at T1 in group D1（P〈0.05）,LFnorm were decreased and HFnorm,LF/HF were increased at T1 and T2in group D2（P〈0.05）.Compared with group C,there were no significant differences at T0 between three groups,5min total heart rates and the average ventricular rate were decreased at T1 and T2in groups D1 and D2（P〈0.05）,RMSSD and PNN50 were significantly increased at T1 and T2in groups D1 and D2.（P〈0.05）.SDNN and HFnorm were increased while LF/HF were significantly decreased at T1 and T2in group D2（P〈0.05）.LF/HF was significantly decreased at T1 in group D1.Conclusion The tension of vagus nerves was increased and that of sympathetic nerve was decreased during dexmedetomidine administration.The balance ratio of the au

关 键 词：右美托咪定 自主神经 心率变异性 

分 类 号：R614[医药卫生—麻醉学]