右美托咪啶对重度二尖瓣狭窄行心脏瓣膜置换术患者麻醉诱导期血流动力学的影响  

Effects of dexmedetomidine on hemodynamics during anesthesia induction in heart valve replacement operation for severe mitral stenosis patients

作　　者：丛昊[1] 陈忠华[1] 周其富[1] 蒋宗明[1] 郑羡河[1] 

机构地区：[1]绍兴市人民医院麻醉科,312000

出　　处：《浙江医学》2016年第23期1902-1905,共4页Zhejiang Medical Journal

摘　　要：目的评价右美托咪啶对重度二尖瓣狭窄行心脏瓣膜置换术患者麻醉诱导期血流动力学的影响。方法将择期行心脏瓣膜置换术的重度二尖瓣狭窄患者60例按随机数字表法分为右美托咪啶复合小剂量芬太尼5.0μg/kg组(Ⅰ组),小剂量芬太尼5.0μg/kg组(Ⅱ组),大剂量芬太尼10.0μg/kg组(Ⅲ组),每组20例。Ⅰ组麻醉诱导前输注右美托咪啶0.8μg/kg(输注时间10 min),Ⅱ组与Ⅲ组给予等容量0.9%氯化钠溶液。麻醉诱导时Ⅰ、Ⅱ、Ⅲ组给予芬太尼分别为5.0、5.0和10.0μg/kg。脑电双频指数值低于50时行气管插管接麻醉机通气。记录麻醉诱导前(T1)、导管进入声门(T2)、插管后1 min(T3)、3 min(T4)和5 min(T5)血压和心率(HR),观察麻醉诱导期间心血管不良事件的发生情况以及药物干预的情况。结果与T1比较,3组患者T2时点收缩压(SBP)均显著下降,而Ⅱ组和Ⅲ组HR则显著上升(P<0.05或0.01);与Ⅱ组比较,Ⅰ组T3和T4时点SBP和HR上升程度较小(P<0.05)。与Ⅲ组比较,Ⅱ组高血压和心动过速的发生率升高,Ⅰ组和Ⅱ组低血压发生率降低,Ⅰ组药物干预率降低(P<0.05);与Ⅱ组比较,Ⅰ组高血压、低血压和心动过速发生率降低,心动过缓发生率升高,药物干预率降低(P<0.05)。结论右美托咪啶(0.8μg/kg)复合小剂量芬太尼(5μg/kg)有利于稳定重度二尖瓣狭窄行心脏瓣膜置换术患者麻醉诱导期血流动力学指标。Objective To investigate the effects of dexmedetomidine on the hemodynamics during anesthesia induction in heart valve replacement operation for severe mitral stenosis patients. Methods Sixty patients undergoing heart valve replacement, were enrolled and randomly divided into 3 groups（n=20 in each）： dexmedetomidine combined with low-dose fentanyl（5.0μg/kg） group（group I）, low-dose fentanyl（5.0μg/kg） group（group Ⅱ） and high-dose fentanyl（10μg/kg） group（group Ⅲ）.Dexmedetomidine 0.8 μg/kg was injected over 10 min in groupⅠ, while same volume of normal saline were given in other two groups. When bispectral index was below 50, patients were intubated and ventilated. Blood pressure and heart rate were recorded before induction（T1）, tube entering glottis（T2）, 1 min（T3）, 3 min（T4） and 5 min（T5） after tracheal intubation. The adverse cardiovascular events（hypertension, hypotension, tachycardia and bradycardia） and drug intervention were recorded during anesthesia induction. Results Systolic blood pressure in T2 was significantly decreased in three groups when compared to T1. In comparison with group Ⅱ, systolic blood pressure and heart rate of group I at T3 and T4had less fluctuation. Compared to group Ⅲ,the rate of hypertension and tachycardia was significantly increased in group II, the rate of hypotension decreased in groups Ⅱ andⅠ, the incidence of drug intervention decreased in group I（P〈0.05）. Compared to group II, the incidence of hypertension,hypotension and tachycardia was significantly decreased in group I, whereas increased incidence of bradycardia was observed,consequently, decreased incidence of drug intervention was found（P〈0.05）. Conclusion Dexmedetomidine（0.8μg/kg） combined with low-dose fentanyl（5.0μg/kg） is appropriate for maintaining stable hemodynamics during anesthesia induction in heart valve replacement operation for severe mitral stenosis patients.

关 键 词：右美托咪啶 二尖瓣狭窄 心脏瓣膜置换术 血流动力学 

分 类 号：R614[医药卫生—麻醉学]