右美托咪定对头低位腹腔镜直肠癌根治术患者QTc间期和Tp-e间期的影响

Effect of dexmedetomidine on QTc and Tp-e intervals in patients during laparoscopic radical resection of rectal cancer with steep trendelenburg position

目的探讨右美托咪定对头低位腹腔镜直肠癌根治术患者校正QT间期(QTc)和T波峰值至终点时间(Tp-e间期)的影响。方法选择择期行腹腔镜直肠癌根治术患者60例,年龄45~60岁,ASAⅠ或Ⅱ级,采用随机数字表法分为右美托咪定组(D组)和对照组(C组),每组30例。从麻醉诱导开始至头低位结束,D组静脉持续泵注右美托咪定0.3μg/(kg·h),C组持续泵注同等剂量的生理盐水。记录麻醉诱导前平卧位(T_0)、人工气腹头低位后30 min(T_1)、60 min(T_2)、90 min(T_3)、解除气腹平卧位后15 min(T_4)、60 min(T_5)各时点QTc间期、Tp-e间期的变化,以及心率(HR)、平均动脉压(MAP)、两组患者手术结束至拔管时间,苏醒期躁动发生率等。结果 C组T_1~T_5时QTc(ms)间期分别为(390.7±4.2)、(397.3±4.0)、(395.4±5.2)、(407.5±4.4)、(406.1±4.4),与T_0比较,T_1~T_5时QTc间期明显延长(P<0.05)。D组T_2~T_5时QTc(ms)间期分别为(377.9±4.7)、(376.6±5.1)、(385.4±4.3)、(378.7±4.2),与T_0比较,仅T_4时QTc间期有所延长,差异有统计学意义(P<0.05),其余各时点差异均无统计学意义(P>0.05)。与C组比较,D组T_2~T_5时QTc间期明显缩短,差异有统计学意义(P<0.05)。D组T_1~T_4时HR(bpm)分别为(69.1±13.7)、(67.0±12.6)、(65.4±11.9)、(64.6±12.2),与T_0比较,T_1~T_4时HR明显减慢(P<0.05)。与C组比较,D组HR在T_1~T_4时亦明显减慢(P<0.05)。两组患者组内、组间比较Tp-e间期、MAP均未见明显变化(P>0.05)。两组患者手术结束至拔管时间差异无统计学意义(P>0.05)。D组苏醒期躁动发生率明显低于C组(P<0.05)。两组患者术中低血压、心动过缓发生率比较差异无统计学意义(P>0.05),未见严重心血管不良事件发生。结论右美托咪定可以明显缩短头低位腹腔镜直肠癌根治术患者的QTc间期、降低心血管不良事件的发生,减少苏醒期躁动的发生。

Objective To investigate the effects of dexmedetomidine on corrected QT （QTc） and T -wave peak to end point （Tp -e interval） in patients undergoing laparoscopic radical resection of rectal cancer with Steep Trendelenburg Position. Methods Sixty cases, aged 45 - 60 years old, ASA I or Ⅱ, who were scheduled with laparoscopic radical resection of rectal cancer, were randomly divided into two groups ： group C and group D （ n = 30）. D group intravenous infusion of dexmedetomidine at 0.3 p^g/（ kg ~ h） , and volume matched 0.9% saline infusion was administered in group C, from the beginning to the end of the pneumoperitoneum with Steep Trendelenburg Position. Time points of QTc and Tp - e intervals and hemodynamic parameters were recorded before induction with supine position （ To ）, 30rain （ T1 ） , 60 rain（ T2 ）, 90min（ T3 ） after pneumoperitoneum with Steep Trendelenburg Position, 15 min（ T4 ） , 60min（ T5 ） after remove the pneumoperitoneum and Steep Trendelenburg Position, and the time from the end of the operation to extubation, the incidence of agitation during recovery period. Results In group C, the QTc （ ms ） intervals at T2- T5 were （ 390.7 ±4.2）, （ 397.3±4.0）, （ 395.4 ±5.2）, （407.5 ±4.4） and （406.1 ±4.4）, respectively, which were signif- icantly increased compared with that at TO （ P 〈 0.05 ）. In group D, there was no significant difference of QTc interval compared with that at TO （ P 〉 0.05 ）, except at T4 （ P 〈 0.05 ）. The QTe （ms） intervals in group D at T2 - T5 was significantly shortened compared with group C （P 〈0.05）. The HR（bpm） of group D were respectively （69.1 ± 13.7） , （67.0±12.6）, （65.4±11.9） and （64.6±12.2） at T1-T4 which were slower than that at T0 and at the corresponding time point of group C （ P 〈 0.05 ）. HR of group C were no significantly different （P 〉 0.05 ）. There was no significant different of Tp - e interval and MAP inside and between groups （ P 〉 0.05 ）. The time from the end of the operation to extubation was no significant difference between groups （ P 〉 0.05 ）. The incidence of agitation in group D was significantly lower than group C （ P 〈 0.05 ）. There was no significant difference in the incidence of hypotension and bradyeardia between the two groups （ P 〉 0.05 ）. No serious adverse cardiovascular events occurred. Concinsion Dexmedetomidine would significantly reduce the QTe interval and the incidence of agitation in patients who undergoing laparoscopie radical resection of rectal cancer with Steep Trendelenburg Position, then reduce the incidence of adverse cardiovascular events.