低剂量右美托咪定对老年糖尿病患者围术期循环及心率变异性的影响

Effects of low-dose dexmedetomidine on perioperative circulation and heart rate variability in elderly patients with diabetes mellitus

目的 探讨低剂量右美托咪定对老年糖尿病患者围术期循环及心率变异性的影响。方法 选择2016年1-6月慈林医院择期行下肢手术的老年糖尿病患者40例,采用随机数字表法分为右美托咪定组（D组）和对照组（C组）,各20例。D组于麻醉诱导前静脉泵注右美托咪定,负荷剂量0.2μg/kg（4μg/m L）10 min泵完,并以0.2μg/（kg·h）持续泵注至手术结束前30 min;C组静脉泵注等容量的0.9%氯化钠溶液。所有患者于术前、术后第1天（从手术结束开始）和术后第2天（第2个24 h）行动态心电图监测患者心率变异性（HRV）;并于入室后（T0）、麻醉诱导前（T1）、麻醉诱导后（T2）、气管插管即刻（T3）、手术开始即刻（T4）、手术结束（T5）记录两组患者平均动脉血压（MAP）和心率（HR）,并记录手术时间、苏醒时间及术中不良事件的发生情况。结果 与D组比较,C组患者T3、T4时MAP和HR均明显增高（P〈0.05）;与T0时比较,C组患者在T3、T4时MAP和HR均明显增高（P〈0.05）;术中高血压的发生率C组明显高于D组（P〈0.05）;术后第1天,两组患者SDNN、SDANN和C组患者RMSSD均低于术前,其中C组各指标均低于D组（P〈0.05）;术后第2天,两组各指标均较术前第1天进一步下降,其中C组各指标均低于D组（P〈0.05）。结论 低剂量右美托咪定应用于老年糖尿病患者,能减少术中循环波动,并促进患者早期HRV相关指标的恢复。

Objective To investigate the effect of low-dose dexmedetomidine on perioperative circulation and heart rate variability in elderly patients with diabetes mellitus. Methods 40 elderly patients with diabetes undergoing elective lower limb surgery at Cilin Hospital from January to June in 2016 were enrolled in this study. They were assigned to dexmedetomidine group（group D） and control group（group C） according to the random number table, with 20 cases in each group. The group D was given dexmedetomidine by intravenous pump before anesthesia induction, with the loading dose of 0.2 μg/kg（4 μg/m L） for 10 min, and continuous injection with 0.2 μg/（kg·h） was given until 30 min before the end of the surgery; group C was given 0.9% sodium chloride solution of equal volume by intravenous pump. Heart rate variability（HRV） was monitored in all patients before the surgery, on the first day（from the end of surgery） and the second day（the second 24 hours） after the surgery by dynamic ECG; the mean arterial blood pressure（MAP） and heart rate（HR） were recorded in two groups after entering into the operation room（T0）, before induction of anesthesia（T1）, after induction of anesthesia（T2）, immediately after tracheal intubation（T3）, immediately after operation（T4） and at end of operation（T5）, and the time of surgery, the time of awakening and the incidence of adverse events were recorded. Results Compared with group D, MAP and HR in group C at T3 and T4were significantly higher（P〈0.05）; compared with T0,MAP and HR were significantly increased in at T3 and T4in group C（P〈0.05）; the incidence of intraoperative hypertension in group C was significantly higher than that in group D（P〈0.05）; on the first day after operation, SDNN, SDANN in both groups and RMSSD in group C were lower than those before the surgery, among them, the indices in group C were all lower than those in group D, and the differences were statistically significant（P〈0.05）; on the second day after operation, the indices in both groups were decreased further than those on the first day before operation. The indices in group C were all lower than those in group D（P〈0.05）. Conclusion Low-dose dexmedetomidine can reduce circulatory fluctuation and promote early recovery of related indices of HRV in the elderly patients with diabetes mellitus.