右美托咪定不同给药方法对心脏瓣膜置换术时血流动力学及心脏复跳的影响  

Effects of different administration methods of dexmedetomidine on hemodynamics and heart re-beating during heart valve replacement

作　　者：高慎强[1] 关善辉[1] 韩沛坤 GAO Shen-qiang;GUAN Shan-hui;HAN Pei-kun(Department of Anesthesia,Taian Central Hospital,Taian 271000,China)

机构地区：[1]山东省泰安市中心医院麻醉科,271000

出　　处：《中国现代药物应用》2020年第14期4-7,共4页Chinese Journal of Modern Drug Application

摘　　要：目的比较右美托咪定(Dex)预处理、后处理和全程泵注对心脏瓣膜置换术时血流动力学及心脏复跳的影响。方法 120例择期行瓣膜置换术的患者,随机分为D1组(Dex预处理)、D2组(Dex后处理)、D3组(Dex全程泵注)、C组(空白对照),各30例。D1组于麻醉诱导前给予Dex0.5μg/kg,继之以0.5μg/(kg·h)泵注至主动脉阻断前;D2组于主动脉阻断后给予与D1组相同剂量Dex至主动脉开放;D3组于麻醉诱导前给予与D1组相同剂量Dex至手术结束;C组泵入与D3组等容的生理盐水。比较四组患者术中各时间点[T0(入室后5 min,泵注实验药物之前)、T1(注射完负荷剂量后即刻)、T2(气管插管后1 min)、T3(劈胸骨后1 min)、T4(主动脉阻断前即刻)、T5(停机后30 min)、T6(手术结束时)]平均动脉压(MAP)、心率(HR)水平以及心脏复跳情况、用药情况。结果与T0比较, C组、D2组T2、T3时MAP、HR水平均升高, D1组、D3组T1时MAP、HR水平均降低,四组T5、T6时HR水平均升高、MAP水平均降低,差异均具有统计学意义(P<0.05);四组T2时MAP、HR水平与T3时比较,差异均无统计学意义(P>0.05)。D1组、D3组患者T1、T2、T3时MAP、HR水平均低于C组,差异具有统计学意义(P<0.05);D1组、D3组在T2、T3时MAP、HR水平均低于D2组,差异具有统计学意义(P<0.05)。D1、D3组患者各时间点MAP、HR水平比较,差异无统计学意义(P>0.05)。D1、D2、D3组患者心脏复跳时间分别为(138.5±12.7)、(140.2±10.8)、(143.6±8.5)s,均长于C组的(102.4±15.2)s,差异均有统计学意义(P<0.05);D1、D2、D3组患者自动复跳率分别为53.3%、50.0%、80.0%,均高于C组的23.3%,差异均有统计学意义(P<0.05);D1、D2、D3组患者室颤及其他心律失常发生率分别为53.3%、56.7%、26.7%,均低于C组的86.7%,差异均具有统计学意义(P<0.05)。D1、D2、D3组患者心脏复跳时间组间两两比较,差异无统计学意义(P>0.05);D1、D2组患者自动复跳率均低于D3组,室颤及其他心律�Objective To compare the effect of dexmedetomidine(Dex) pre-treatment, post-treatment and pump injection on hemodynamics and heart re-beating during heart valve replacement. Methods A total of 120 patients with selective heart valve replacement were randomly divided into D1 group(Dex pre-treatment), D2 group(Dex post-treatment), D3 group(Dex pump injection), and C group(blank control), with 30 cases in each group. D1 group received Dex 0.5 g/kg before anesthesia induction, followed by 0.5 g/(kg·h) pump injection before the aortic occlusion. D2 group received the same dose of Dex as the D1 group after the aorta was blocked until the aortic cross-clamp removal. D3 group received the same dose of Dex as D1 group to the end of the operation anesthesia induction. C group was pumped with the same volume of saline as D3 group. The mean arterial pressure(MAP) and heart rate(HR) at different time points [T0(5 min after entering the room, before pumping), T1(immediately after injection of loading dose), T2(1 min after tracheal intubation), T3(1 min after splitting the sternum), T4(immediately before aortic occlusion), T5(30 min after shutdown) and T6( end of surgery)], heart re-beating and drug use were compared among the four groups. Results Compared with those at T0, MAP and HR level of C group and D2 group increased at T2 and T3, while MAP and HR level of D1 and D3 group decreased at T1. At T and T6, HR level of the four groups was higher than those at T0, and MAP level was lower than those at T0, and the differences were statistically significant(P<0.05). MAP and HR level at T2 of the four groups had no statistically significant difference compared with those at T3(P>0.05). At T1, T2, T3, MAP and HR level of D1 and D3 group was lower than those of C group, and the difference was statistically significant(P<0.05). At T2, T3, MAP and HR level of D1 and D3 group was lower than those of D2 group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in MAP and HR level

关 键 词：右美托咪定 给药方法 血流动力学 心脏复跳 

分 类 号：R614[医药卫生—麻醉学]