小剂量右美托咪定联合全麻对择期下腹部手术并高心血管风险患者术中血流动力学紊乱情况及围术期心脏不良事件发生的影响  

Effect of Low-dose Dexmedetomidine Combined with General Anesthesia on Intraoperative Hemodynamic Disturbance and Occurrence of Perioperative Adverse Cardiac Events in Patients with High Cardiovascular Risk Undergoing Elective Lower Abdominal Surgery

作　　者：卢洋 LU Yang(Jiamusi Hospital of Traditional Chinese Medicine,Heilongjiang Province,Jiamusi 154002,China)

机构地区：[1]黑龙江省佳木斯市中医医院,黑龙江佳木斯154002

出　　处：《中国医学创新》2022年第4期145-149,共5页Medical Innovation of China

摘　　要：目的:探讨小剂量右美托咪定(DEX)联合全麻对择期下腹部手术并高心血管风险患者术中血流动力学紊乱情况及围术期心脏不良事件发生的影响。方法:选取2018年9月-2020年9月于佳木斯市中医医院择期行下腹部手术的高心血管风险患者80例为研究对象。采用随机数字法将患者分为D1组、D2组和对照组(C组)。三组均采取全麻,D1组、D2组分别予以0.4、0.8μg/kg的DEX,C组予以等剂量的0.9%氯化钠溶液。观察三组手术前后实验室指标[超敏心肌肌钙蛋白(hs-TnT)、肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)]检测结果变化情况,比较术中血流动力学紊乱发生率、用药剂量,麻醉苏醒后疼痛[视觉模拟评分法(VAS)]、镇静(Ramsay镇静评分)、躁动(RASS评分)程度及围术期心脏不良事件发生率。结果:术后1 d,三组血清hs-TnT、CKMB、AST水平较术前1 d均升高,且D1组<D2组<C组,差异均有统计学意义(P<0.05);术中血流动力学紊乱发生率比较为D1组<D2组<C组(P<0.05);D1组和D2组乌拉地尔、硝酸甘油使用量均少于C组(P<0.05),D1组和C组麻黄碱、阿托品使用量均少于D2组(P<0.05);D1组和D2组围术期心脏不良事件发生率均低于C组(P<0.05)。结论:小剂量DEX联合全麻更有利于维持围术期血流动力学的稳定,减少心脏不良事件的发生,对合并心血管风险患者有较好的心脏保护作用。Objective:To explore the effect of low-dose Dexmedetomidine (DEX) combined with general anesthesia on intraoperative hemodynamic disturbance and occurrence of perioperative adverse cardiac events in patients with high cardiovascular risk undergoing elective lower abdominal surgery.Method:A total of 80 patients with high cardiovascular risk who underwent elective lower abdominal surgery in Jiamusi Hospital of Traditional Chinese Medicine from September 2018 and September 2020 were selected for the study.80 patients were divided into group D1,group D2 and group C according to the random number method.Three groups were given general anesthesia,and group D1 and group D2 were given 0.4 and 0.8 μg/kg dose of DEX,and group C was given the equal dose of 0.9% Sodium Chloride Solution.The changes of detection results of laboratory indexes[high-sensitivity cardiac troponin (hs-TnT),creatine kinase isoenzyme (CK-MB),aspartate aminotransferase (AST),lactate dehydrogenase (LDH)]were observed among three groups before and after operation,and the incidence rate of intraoperative hemodynamic disturbance,drug dosage,Pain after anesthesia recovery[visual analogue scale (VAS)],sedation (Ramsay sedation score),agitation (RASS score) degree and incidence rates of perioperative cardiac adverse events were compared.Result:At 1 d after operation,the serum levels of hs-TnT,CK-MB and AST in three groups were higher than those at 1 d before operation,and the comparison among the groups showed group D1< group D2< group C,the differences were statistically significant (P<0.05).The incidence rate of intraoperative hemodynamic disturbance showed group D1< group D2< group C (P<0.05).The doses of Urapidil and Nitroglycerin in group D1 and group D2 were less than that in group C,and the doses of Ephedrine and Atropine in group D1 and group C were lower than those in group D2,the differences were statistically significant (P<0.05).The incidence rates of perioperative cardiac adverse events in group D1 and group D2 were lower than that in group C (

关 键 词：小剂量右美托咪定 心血管风险 血流动力学 心脏保护 

分 类 号：R614.2[医药卫生—麻醉学]