右美托咪定对轻度心功能不全患者腹腔镜手术围手术期心功能的影响

Effect of dexmedetomidine on perioperative cardiac function in patients with mild cardiac dysfunction undergoing laparoscopic surgery

目的观察右美托咪定对轻度心功能不全患者腹腔镜直肠癌根治术围手术期心功能的影响。方法选择择期行腹腔镜直肠癌根治术同时伴有轻度心功能不全的患者60例，纽约心脏病学会（NYHA）心功能分级Ⅰ～Ⅱ级，美国麻醉医师协会（ASA）分级Ⅱ～Ⅲ级，年龄63～72岁，采用随机数字表法将其分为右美托咪定组（D组）和对照组（C组），每组各30例。D组于麻醉诱导开始时给予负荷剂量右美托咪定0.5 μg/kg，静脉泵注时间大于10 min，后以0.3 μg/（kg·h）速度持续静脉泵注60 min。C组持续泵注同等剂量0.9%氯化钠。应用彩色多普勒超声监测对比两组患者麻醉诱导前（T0）、给药后20 min（T1）、40 min（T2）、60 min（T3）外周循环阻力（SVR）、左室舒张末容积（LVEDV）、左室射血分数（LVEF）、心输出量（CO）、心肌工作指数（Tei指数）以及各时点的心率（HR）、平均动脉压（MAP）的变化，同时观察气管拔管时间及苏醒期躁动发生率等情况。结果D组T1～T3时SVR较T0明显降低[（883 ± 30）、（827 ± 36）、（804 ± 38）dyn·s·cm^-5比（1 075 ± 37）dyn·s·cm^-5]，差异有统计学意义（P〈0.05）；与C组比较，D组T1～T3时SVR亦明显降低，差异有统计学意义（P〈0.05）。D组T1～T3时CO与T0比较差异无统计学意义（P〉0.05）；与D组比较，C组T1～T3时CO明显降低[（3.4 ± 0.6）L/min比（4.4 ± 1.0）L/min、（3.2 ± 0.7）L/min比（4.3 ± 0.8）L/min、（3.3 ± 0.9）L/min比（4.4 ± 0.9）L/min]，两组比较差异有统计学意义（P 〈 0.05）。D组T1～T3时LVEF与T0比较差异无统计学意义（P〉0.05）；与D组比较，C组T1～T2时LVEF明显降低，差异有统计学意义（P〈0.05）。D组T1～T3时Tei指数与T0比较差异无统计学意义（P〉0.05）；与D组比较，C组T1～T2时Tei指数明显升高，差异有统计学意义（P〈0.05）。两组LVEDV组内和组间比较差异无统计学意义（P〉0.05）。D组T1～T3时HR较T0明显降低[（68.1 ± 12.8）、（67.3 ± 11.9）、（65.4 ± 11.7）次/min比（88.2 ± 15.1）次/min]（P 〈 0.05），与C组比较，D组T1～T3时HR亦明显减慢。D组MAP在T1时明显升高，明显高于T0和C组。两组患者手术结束至拔管时间比较差异无统计学意义（P 〉 0.05），D组苏醒期躁动发生率明显低于C组。结论右美托咪定能够有效促进心功能不全患者腹腔镜直肠癌根治术围手术期心功能恢复，提示其具有一定的心肌保护作用。

ObjectiveTo investigate the effect of dexmedetomidine on perioperative cardiac function in patients with mild cardiac dysfunction undergoing laparoscopic radical resection of rectal cancer.MethodsSixty patients scheduled with laparoscopic radical resection of rectal cancer with mild heart failure were selected, with New York Heart Association （NYHA） cardiac function gradingⅠ to Ⅱ, American Association of Anesthesiologists （ASA） grading Ⅱ to Ⅲ, and age from 63 to 72 years. The patients were divided into dexmedetomidine group （group D） and control group （group C） according to the random digits table method with 30 cases each. At the beginning of induction, the patients in group D were given intravenous infusion a loading dose of dexmedetomidine at 0.5 μg/kg for more than 10 min. Then continuous intravenous infusion of dexmedetomidine was given at 0.3 μg/（kg·h） for 60 min. The patients in group C were given 0.9% sodium chloride with the same method. The small vessel resistance （SVR）, left ventricular end-diastolic volume （LVEDV）, left ventricular ejection fraction （LVEF）, cardiac output （CO） and myocardial working index （Tei index） before induction （T0） and after administration of 20 min （T1）, 40 min （T2）, 60 min （T3） were measured by color Doppler ultrasound, and the heart rate （HR） and mean arterial pressure （MAP） were recorded at the same times. The time from the end of operation to extubation and incidences of agitation during recovery period were recorded.ResultsThe T1 to T3 SVR in group D were significantly lower than those of T0： （883 ± 30）, （827 ± 36） and （804 ± 38） dyn·s·cm^-5 vs. （1 075 ± 37） dyn·s·cm^-5, and there were statistical differences （P〈0.05）; compared with those in group C, the T1 to T3 SVR in group D were significantly lower, and there were statistical differences （P〈0.05）. In group D, there were no statistical differences in CO between T1 to T3 and T0 （P〉0.05）; compared with those in group D, the T1 to T3 CO in group C were significantly lower： （3.4 ± 0.6） L/min vs. （4.4±1.0） L/min, （3.2 ± 0.7） L/min vs. （4.3 ± 0.8） L/min and （3.3 ± 0.9） L/min vs. （4.4 ± 0.9） L/min, and there were statistical differences （P〈0.05）. In group D, there were no statistical differences in LVEF between T1 to T3 and T0 （P〉0.05）; compared with those in group D, the T1 to T2 LVEF in group C were significantly lower, and there were statistical differences （P〈0.05）. In group D, there were no statistical differences in Tei index between T1 to T3 and T0 （P〉0.05）; compared with group D, the T1 to T2 Tei index in group C were significantly higher, and there were statistical differences （P〈0.05）. There were no statistical differences in LVEDV after intra-group and inter-group comparison （P〉0.05）. In group D, the T1 to T3 HR were significantly lower than T0： （68.1 ± 12.8）, （67.3 ± 11.9） and （65.4 ± 11.7） times/min vs. （88.2 ± 15.1） times/min, and there were statistical differences （P〈0.05）; compared with those in group C, the T1 to T3 HR in group were significantly slower. In group D, the T1 MAP significantly increased, significantly higher than those in T0 and in group C （P 〈 0.05）. There was no statistical difference in the time from the end of operation to extubation between 2 groups （P〉0.05）. The incidence of agitation during recovery period in group D was significantly lower than that in group C.ConclusionsDexmedetomidine can effectively promote the perioperative cardiac function recovery in patients with cardiac dysfunction undergoing laparoscopic radical resection of rectal cancer, suggesting that it has a certain myocardial protection effect.