盐酸右美托咪定对老年冠心患者全麻气管插管期心率变异性的影响

Effect of Dexmedetomidine on Heart Rate Variability of Elderly Coronary Heart Disease Patients During Intubation

目的：研究盐酸右美托咪定（dexmedetomidine．Dex）在全麻诱导气管插管期间对老年冠心病患者自主神经系统功能的影响。方法：98例择期腹部手术老年冠心病患者．随机分成盐酸右美托咪定（D组n=49，诱导前给予负荷剂量右美托咪定0．7ug，／0g．注射泵缓慢静脉注射．输注时间超过10rain．维持剂量以0．4ug/（kg·h）持续静脉注射）和安慰剂组（P组n=49．诱导前静脉注射等容量氯化钠溶液）．分别于麻醉前（To）．麻醉诱导后（T1）及气管插管后（T2）用心率变异功率谱分析（heart rate Power spectrum analysis．HRPSA）技术观察患者的心率变异性（heart rate variability．HRV）改变。结果：麻醉诱导后．两组HRV总功率频段（TP）和其中低频段（LF）、高频段（HF）．LF／HF（低频／高频比）均显著降低（P〈O．05）．组问比较D组LF低于P组（P〈O．05）；气管插管后，两组LF、HF及TP均显著升高（P〈O．05），而D组的LF／HF较麻醉前（T0）差异无统计意义，P组的LF／HF较麻醉前（T0）显著升高（P〈O．05）：组间比较D组LF、TP升高程度显著低于P组（P〈0．05）．HF组间差异无统计学意义。结论：盐酸右美托咪定能明显抑制插管操作引起的对植物神经功能的干扰，有利于维护老年冠心病患者围插管期心脏的自主神经调节功能。

Objective： To explore the effect of dexmedetomidine （Dex） on autonomic nervous system function during intubation in the elderly patients with coronary heart disease. Methods： 98 patients undergoing abdominal surgery patients with coronary heart disease, were randomly divided into dexmedetomidine group（group D, n=49, the patients received intravenous in jection of Dex（0.7ug / kg）10 minutes before intuba tion,） and then received continuous in jection of Dex a t a rate0.4 ug / （kg.h） during the operation and placebo group （groupP, n=49 Before induction intravenous infusion of the same amount of normal saline）, In preanesthesia （To）, after the induction of anesthesia （T1） and after intubation （T2） the heart rate variability （HRPSA） was observed with power spectral analysis. Results： After induction of anesthesia, both groups of total power of HRV spectrum （TP） and low-frequency （LF）, high frequency （HF）, LF / HF （low frequency / high frequency ratio） were significantly lower than before induction of anesthesia （P 〈0.05）, inter-group comparison group D LF lower than group P （P 〈0.05）; After tracheal intubation, two groups of LF, HF and TP were significantly higher than before tracheal intubation （P 〈0.05）, D group of LF / HF were not significantly higher than before tracheal intubation,however, P group of LF / HF were significantly higher than before tracheal intubation（P 〈0.05）,inter-cjroup comparison Group D with LF, TP increased significantly lower than the group P （P 〈0.05）, HF inter-group difference was not significant. Conclusion： Dexmedetomidine inhibit the intubation stimulation on autonomic function. This is beneficial to maintain good cardiac autonomic nerve function for old patients with coronary artery disease during intubation.