右美托咪定在全身麻醉术中窦性心动过缓的临床观察  

Clinical Observation on Sinus Bradycardia in General Anesthesia combined with Dexmedetomidine

作　　者：孙贺斌 费建平[1] 王欢锋[1] 赵赢 姜玲[2] SUN Hebin;FEI Jianping;WANG Huanfeng(Kunshan City Hospital of Traditional Chinese Medicine,Kunshan City,Jiangsu Province 215300)

机构地区：[1]江苏省昆山市中医医院麻醉科,215300 [2]江苏省昆山市中医医院手术室,215300

出　　处：《医学理论与实践》2019年第20期3224-3226,3232,共4页The Journal of Medical Theory and Practice

摘　　要：目的:通过对全麻术中窦性心动过缓的观察,探讨右美托咪定复合全麻术中窦性心动过缓的安全边际及处理原则。方法:2018年2-9月,80例单侧上、下肢手术随机分成观察组(n=40)与对照组(n=40)。两组均采用外周神经阻滞复合喉罩通气全身麻醉;观察组在完成神经阻滞后,麻醉诱导开始前10min泵注右美托咪定0.6μg/kg为负荷量,术中维持剂量为0.1~0.2μg/(kg·h);对照组泵注等量生理盐水。观察并记录患者T0(基础值)、T1(麻醉后)、T2(术中15min)、T3(术后)时的MAP、HR;观察手术开始后至术毕唤醒前患者最慢心率、最快心率和心率变动范围;观察术中窦性心动过缓发生情况,统计心室率≤60次/min、≤50次/min和≤45次/min的例数和占比,窦性心动过缓持续时间等。结果:所有患者均顺利完成手术,围术期无不良循环改变事件发生。与对照组比较:观察组T1时MAP及T1、T2时HR下降有统计学意义(P<0.05);观察组和对照组患者术中最慢心率分别为:(48.56±5.87)次/min、(52.67±4.73)次/mim,组间比较差异有显著统计学意义(P<0.001);观察组术中心率变动范围低于对照组[(8.22±4.11)次/min VS (12.82±4.98)次/min],差异有显著统计学意义(P<0.001);观察组患者术中最慢心率≤45次/min发生例数、最慢心率≤50次/min发生例数、最慢心率≤60次/min发生例数均比对照组多,差异有显著统计学意义(P<0.001)。37例观察组患者术中发生窦缓且都能维持心率稳定性。结论:在全身麻醉手术中给予0.6μg/kg的右美托咪定负荷量,窦性心动过缓发生时仍然维持植物神经的稳定性;心室率43~45次/min是窦缓发生时的安全边际,建议设定心室率43次/min作为临床干预的指标,小剂量使用阿托品(0.3~0.35mg)防止窦性停搏安全有效。Objective:To investigate the safety margin and management principles of sinus bradycardia during general anesthesia combined with dexmedetomidine by observing the effect of dexmedetomidine on sinus bradycardia.Methods:From February to September 2018, 80 cases of unilateral upper limb or lower limb surgery were randomly divided into observation group(n=40) and control group(n=40). Nerve block combined with laryngeal mask ventilation was used for general anesthesia in observation group and control group. After completion of nerve block, dexmedetomidine was micropump injected with a dose of 0.6μg/kg in 10 minutes and 0.1~0.2μg/(kg·h) was maintained during the operation in the observation group but the control group was injected with the same amount of saline by micropump.MAP and HR were recorded before dosing(T0),10 minutes after anesthesia(T1),15 minutes during operation(T2) and postoperative(T3);the slowest heart rate or the fastest heart rate and the range of heart rate changes were observed from the beginning of operation to the end of awakening.The occurrence of sinus bradycardia during operation was also observed.The number and proportion of ventricular rate less than 60 beats/min, less than 50 beats/min, less than 45 beats/min were counted,and the duration of sinus bradycardia was recorded.Results:All the patients completed the operation successfully,No adverse circulatory events occurred during the perioperative period. Compared with the control group: the decrease of HR at T1 and T2,the decrease of MAP at T1 in the observation group with statistically significant(P<0.05).The slowest heart rate in observation group was lower than that in control group[(48.56±5.87) beats/min VS(52.67±4.73)beats/min)with significant differences(P<0.001).The range of heart rate fluctuation in the observation group [(8.22±4.11) beats/min] during operation was smaller than that in the control group [(12.82±4.98) beats/min],and there was significant difference(P<0.001).There were significant differences among the two groups

关 键 词：右美托咪定 全身麻醉 窦性心动过缓 心率变异性 

分 类 号：R614[医药卫生—麻醉学]