兰地洛尔对Ⅱ型糖尿病患者气管插管心率变异性及QT间期的影响

Effects of landiolol on heart rate variability and QT interval during tracheal intubation in patients with typeⅡdiabetes

目的:评价兰地洛尔在麻醉诱导气管插管时对Ⅱ型糖尿病患者心率变异性(HRV)和QT间期的影响。方法:40例择期实施气管插管全麻手术的糖尿病患者,ASA分级Ⅱ级,随机分为兰地洛尔组(L组,n=20)和对照组(C组,n=20),比较插管前后心率变异性和QT间期的变化。L组在插管前2min静脉缓慢注射兰地洛尔0.1mg·kg-1·min-1 1min,然后以0.04mg·kg-1·min-1的速度持续输注至插管后5min;C组给予等量生理盐水。记录麻醉诱导前(T0)、插管即刻(T1)、插管后1min(T2)、插管后3min(T3)、插管后5min(T4)时HRV各参数、心率(HR)、平均动脉压(MAP)、QT间期的变化。结果:T1-4时,L组低频高频比(LF/HF)显著低于C组;C组QTLC显著长于T0时(P<0.05),且明显长于L组(P<0.05)。结论:兰地洛尔可降低LF/HF,有效抑制交感神经活性,维持交感副交感神经相对均衡,缩短与气管插管有关的QT间期的延长,可能与其抑制交感神经活性,维持交感副交感神经相对均衡有关,可降低糖尿病患者麻醉期间心脏意外的风险。

AIM. To evaluate effects of landiolol on heart rate variability （HRV） and QTc interval during tracheal intubation in patients with type II diabetes. METHODS： Forty patients with type II diabetes were randomly allocated either to landiolol group （group L） or to control group （ group C ）. A bolus of 0. 1 mg· kg-1·min-1 landiolol was administered to the group L for one minute at two minutes be- fore tracheal intubation and followed by a continuous infusion at a rate of 0.04 mg· kg-1 · min 1; group C received the same volume of saline. The changes in HRV and QT interval were recorded and compared between the two groups at following time points： preinduction （To）, intubation （T1） and lmin （T2）, 3 min （T3）, 5 min （T4） after intubation. RESULTS：At T1 to T4, LF/HF were lower significantly in group L than those in group C. QT intervals were lengthened remarkably at T1 to T4 in the group C than those in the group L （P〈 0.05）. CONCLUSION： Landiolol can inhibit effectively the sympathetic nervous system activity and improve the balance between the sympathetic and parasympathetic nervous system. Landiolol can also shorten the QT interval prolongation associated with tracheal intubation.