负荷量右美托咪定对全麻非心脏手术患者血压心率的影响

Effect of load dexmedetomidine on blood pressure and heart rate in patients undergoing general anesthesia and non-cardiac surgery

目的探讨全麻维持期给予负荷剂量右美托咪定对择期非心脏手术患者血流动力学的影响。方法选取我院2019年3~9月择期拟全麻下行非心脏手术患者145例,ASAⅠ~Ⅱ级。随机分为两组:Dex组73例和NS组72例,分别在切皮前10min经微量泵给予0.5μg/kg右美托咪定或等容积生理盐水,输注15min。记录从泵注开始后连续60min内患者的SBP、MBP、DBP和HR。结果泵注开始后15min Dex组血压逐渐上升,之后逐渐下降,30min后血压逐渐趋于平稳;NS组血压无此变化趋势;但两组间血压差异无统计学意义。Dex组HR在给药后5min逐渐低于NS组,约30min后两组间HR差异有统计学意义,Dex组平均HR比NS组低3.9次/min。Dex组HR<50次/min的发生率明显高于NS组(43.8%vs 27.8%,RR=1.58,95%CI:1.002~2.485,P=0.044)。结论麻醉维持期间给予负荷量为0.5μg/kg右美托咪定对行非心脏手术患者血压无明显影响,但可明显降低患者心率,使严重心动过缓的发生风险明显增加。

Objective To explore the effect of loading dose dexmedetomidine on hemodynamics in patients undergoing elective non-cardiac surgery during the maintenance period of general anesthesia.Methods 145 ASAⅠ-Ⅱpatients,who were scheduled to undergo non-cardiac surgery under general anesthesia from March to September 2019,were selected.They were randomly divided into two groups:Dex group(73 cases)and NS group(72 cases).They were respectively given 0.5μg/kg dexmedetomidine or equal volume normal saline by micropump at 10 min,before skin incision for 15 min.The SBP,MBP,DBP and HR of the patients within 60 min after the pump injection were recorded.Results Blood pressure in DEX group gradually increased 15 min after pump injection,then gradually decreased,and gradually stabilized 30 min later.The blood pressure in NS group did not show such change trend.However,there was no statistically significant difference in blood pressure between the two groups.HR in Dex group was gradually lower than that in NS group 5 min after administration,and there was a statistically significant difference of HR between the two groups after about 30 min.The average HR in Dex group was 3.9 times/min lower than that in NS group.The incidence of HR in Dex group<50 times/min was significantly higher than that in NS group(43.8%vs 27.8%,RR=1.58,95%CI:1.002-2.485,P=0.044).Conclusion An administration of dexmedetomidine with a load capacity of 0.5μg/kg during anesthesia maintenance has no obvious effect on blood pressure of patients undergoing non-cardiac surgery,but it can significantly reduce the heart rate of patients and greatly increase the risk of occurrence of severe bradycardia.