探讨右美托咪定对心脏瓣膜置换术患者麻醉诱导期血流动力学的影响

The efficacy of dexmedetomidine on hemodynamics during the anesthesia induction of patients undergoing heart valve replacement surgery

目的:探究心脏瓣膜置换术患者应用右美托咪定在麻醉诱导期对其血流动力学的影响情况,进而合理指导此类手术的麻醉诱导。方法:将我院2016年5月-2019年5月收治的80例心脏瓣膜置换术患者纳入研究,应用随机数字表法分为观察组与对照组,均为40例,观察组应用右美托咪定麻醉诱导,对照组输注生理盐水,并依据不同患者血压、心率变化采取相应的处理措施,评价两组患者在不同麻醉诱导期的心率与血压指标,观察时间点包括:给药前(T0)、给药后10 min(T1)、插管即刻(T2)、插管后1 min(T3)、插管后5 min(T4)、插管后10 min(T5)。结果:观察组患者T1~T5的心率均小于T0,观察组T1~T3心率均小于对照组;对照组T4、T5收缩压小于T0,观察组与对照组T4、T5时的收缩压小于T1,不同数据分析的差异存在统计学意义(P<0.05);观察组心率下降患者数量多于对照组差异存在统计学意义,(P<0.05);两组在血压波动患者数量方面的差异无统计学意义(P>0.05);观察组患者麻醉期间部分时间心输出量(CO)、心指数(CI)、每搏输出量(SV)指标小于对照组,差异存在统计学意义(P<0.05);观察组T1时麻醉分级为3级人员明显多于对照组,差异有统计学意义(P<0.05)。结论:心脏瓣膜置换术患者麻醉诱导期使用右美托咪定,能够降低心率,稳定血流动力学参数,降低心脏手术治疗风险。

Objective:To explore the effect of dexmedetomidine on hemodynamics during the anesthesia induction of patients undergoing heart valve replacement surgery,and to guide the anesthesia induction for this surgery type.Methods:80 cases were divided into the observation group and the control group by random number table method,with 40 cases in each.The observation group was treated with dexmedetomidine anesthesia induction,and the control group was infused with normal saline,and corresponding treatment measures were taken according to the changes in blood pressure and heart rate of different patients.Results:The T1-T5 heart rate in the observation group was less than T0,and the T1-T3 heart rate in the observation group was less than the control group.The T4 and T5 systolic blood pressure in the control group were less than T0,and the systolic blood pressure at T4 and T5 in the observation group and the control group was less than T1(P<0.05).Number of patients with reduced heart rate in the observation group was more than the control group(P<0.05).There was no statistically significant difference between the groups in the number of patients with blood pressure fluctuations(P>0.05).The CO,CI,and SV indicators at part time during anesthesia in the observation group were lower than the control group(P<0.05).There were significantly more people who had an anesthesia classification of level 3 at T1 in the observation group than the control group(P<0.05).Conclusion:Dexmedetomidine on hemodynamics during the anesthesia induction of patients undergoing heart valve replacement surgery can reduce heart rate,stabilize hemodynamic parameters,and reduce the risk of cardiac surgery.