不同剂量右美托咪啶对冠心病患者气管插管血流动力学的影响

Effect of different doses of dexmedetomidine on hemodynamics of coronary artery disease patients with endotracheal intubation

目的研究不同剂量右美托咪啶对冠心病患者气管插管血流动力学的影响。方法择期气管内插管全身麻醉行腹部外科手术冠心病患者75例,随机将其分成L组(右美托咪啶0.5μg/kg)、M组(右美托咪啶1.0μg/kg)、C组(咪唑安定对照组),每组25例。麻醉诱导前静脉泵注用生理盐水稀释成50 ml右旋美托咪啶,L组0.5μg/kg,M组1.0μg/kg,输注时间为20 min;C组全麻诱导时先静脉注射咪唑安定0.03～0.05 mg/kg。记录入室后基础值(T1)、全麻诱导前(T2)、插管前(T3),插管后即刻(T4),插管后3 min(T5)各时点的心率(HR)、有创血压值[收缩压(SBP)、舒张压(DBP)]、心电图(ECG)变化。结果与基础值相比较,输注右美托嘧啶后全麻诱导前L组、M组患者HR、SBP、DBP均下降(P<0.05),但两组之间差异无统计学意义(P>0.05)。气管插管前,三组患者的SBP、DBP、HR均降至最低(与基础值比较,P<0.05);三组间差异均无统计学意义(P>0.05)。气管插管前M组出现4例窦性心动过缓(<52次/min),3例低血压(SBP下降>40%);L组出现1例窦性心动过缓;C组出现1例低血压,2例窦性心动过速。气管插管后即刻三组患者血压、心率有不同程度上升;C组HR、SBP、DBP与插管前L组、M组相比明显上升(P<0.05)。L组、M组与插管前相比差异无统计学意义(P>0.05)。气管插管后3 min,C组血压、心率与气管插管后即刻比较有明显下降(P<0.05);与插管前相比仍明显升高(P<0.05)。L组、M组血压、心率与插管后即刻、插管前比较差异无统计学意义(P>0.05)。结论冠心病患者术前输注右美托咪啶可减少气管插管血流动力学变化;0.5μg/kg右美托咪啶可能更适合冠心病患者。

Objective To investigate the effect of different doses of dexmedetomidine on hemodynamics of coronary artery disease patients with endotracheal intubation. Methods Seventy-five patients with coronary artery disease scheduled for abdominal surgeries under general anesthesia were randomly divided into three groups with 25 cases for each.Patients in group L and group M received intravenuous maintenance dose of dexmedetomidine 0.5 mg/kg and 1.0 mg/kg respectively within 50 ml 0.9% saline at the 20 minutes,while patients in group C received intravenuous injection of 0.03-0.05 mg/kg midazolam before induction of anaesthesia.SBP,DBP,HR and ECG were continuously monitored at five different time which is baseline,before induction,before tracheal intubation,immediately after tracheal intubation,3 minutes after tracheal intubation.Results HR,SBP and DBP of group L and group M were significantly decreased,compared with baseline after intravenuous injection dexmedetomidine（P0.05）,but there was no significant difference between group L and group M（P0.05）.HR,SBP and DBP of the three groups were significantly decreased,compared with baseline before tracheal intubation（P0.05）,and there was no significant difference among the three groups（P0.05）.Four cases of sinus bradycardia（HR52 beats per minute） and 1 case of low blood tension（SBP decreased over 40%） were observed in group M,1 case of low blood tension in group C and no case in group L before tracheal intubation.Immediately after tracheal intubation,HR,SBP and DBP of group C were significantly increased,compared with that before anesthesia induction and these values also raised than other two groups（P0.05）.At 3 minutes after tracheal intubation,HR,SBP and DBP of group C dropped,compared with immediately after tracheal intubation（P0.05） and also significantly increased than that before tracheal intubation.There was no significant difference in HR,SBP and DBP at the time before tracheal intubation,immediately after tracheal intubation,3 minutes after tracheal intubation（P0.05）. Conclusion Perfusion of dexmedetomidine before induction can leads to less variation in hemodynamics during tracheal intubation in patients with coronary artery disease.It could be better option for the dose of dexmedetomidine 0.5 μg/kg.