右美托咪定对高血压患者全身麻醉拔管期心率收缩压乘积和血压心率比值的影响

Study on the influence of dexmedetomidine during decannulation period of general anesthesia in patients with high blood pressure on product of heart rate and systolic blood pressure and the influence on ratio of heart rate and blood pressure

目的观察临床应用右美托咪定对高血压患者全身麻醉拔管期心率收缩压乘积(RPP)、血压心率比值(PRQ)的影响。方法采用前瞻性研究方法选取2015年6月至2017年6月进行全麻手术合并高血压患者96例,通过多中心随机对照试验方法将其分为对照组和观察组各48例,观察组应用右美托咪定治疗,对照组则给予同剂量生理盐水静脉滴注,对比分析两组患者用药前、拔管前、拔管时、拔管后5 min以及拔管后10 min时心率(HR)、血压及RPP、PRQ变化情况,不良反应发生情况。结果用药前两组患者HR、SBP、DBP、MAP以及RPP、PRQ各项指标比较差异均无统计学意义(P>0.05),观察组拔管前、拔管时和拔管后5 min时的SBP、DBP、MAP水平均明显低于对照组(P<0.05),HR则在拔管前以及拔管时较对照组明显降低(P<0.05),用药后拔管期各时间点两组患者RPP比较观察组均明显低于对照组(P<0.05),PRQ则在各时间点两组间均无显著差异(P>0.05)。总体分析,观察组各项指标波动幅度明显小于对照组(P<0.05);观察组不良反应发生率明显低于对照组(P<0.05)。结论临床应用右美托咪定能有效稳定高血压患者全身麻醉拔管期血流动力学指标,降低拔管刺激引起的心血管反应,有效提高拔管质量。

Objective To observe the effect of dexmedetomidine on the product of heart rate and systolic blood pressure(RPP)and ratio of blood pressure and heart rate(PRQ)in extubation period of general anesthesia in patients with hypertension.Methods This prospective study was carried in June2015to June2015,a total of96patients with hypertension underwent general anesthesia for surgery were studied through multi-center randomized control trial method,all these96cases were divided into control group and observation group,each with48cases.Patients in observation group were applied with dexmedetomidine for treatment,patients in control group were given with normal saline for intravenous drip.The medication before drawing tube,tube drawing,5min and10min after extubation and changes in heart rate(HR),blood pressure and RPP,PRQ and incidence of adverse reactions were compared between these2groups.Results The HR,SBP,DBP,MAP and RPP,PRQ indicators in patients of these2groups before using this drug were compared,and the difference had no statistical significance(P>0.05).The SBP,DBP,MAP levels in patients of observation group before extubation and5minutes after extubation were significantly lower than those of control group(P<0.05),while HR before tube drawing and at the time of drawing tube were significantly lower than those of control group(P<0.05).At the period after extubation,patients in both groups at each time point RPP were compared,they in observation group were significantly lower than those of control group(P<0.05).The PRQ in each time point between these two groups had no significant difference(P>0.05).The overall analysis of the fluctuation in observation group was obviously less than that of control group(P<0.05).The incidence rates of adverse reactions in patients of observation group were obviously lower than those of control group(P<0.05).Conclusion The clinical application of dexmedtomidine can effectively keep their blood pressure stable in patients with high blood pressure during decannulation period of general anesthesia,it can keep stable hemodynamic parameters and reduce cardiovascular reactions for stimulation of tube drawing,and effectively raise the quality of tube drawing.