右美托咪定诱导前输注与全程输注对血流动力学影响比较

Effects of Dexmedetomidine infused prior to induction vs whole-process of anasthesia on hemodynamics

目的探讨诱导前输注与全程输注右美托咪定(DEX)对患者血流动力学的影响。方法选择2019年12月至2020年6月在广州医科大学附属中医医院行择期手术并接受气管插管全身麻醉的90例患者为研究对象,随机分为空白对照组(诱导前至术中全程静脉输注生理盐水,背景剂量0.5μg/kg持续输注10 min,随后0.5μg·kg^(-1)·h^(-1)速度输注至术毕)、试验组(诱导前泵注DEX 0.5μg/kg持续输注10 min,随后停药)、全程输注组(诱导前泵注DEX 0.5μg/kg持续输注10 min,随后0.5μg·kg^(-1)·h^(-1)速度输注至术毕)。观察各组DEX使用前(T0)、DEX静脉注射完成时(T1)、气管插管前(T2)、插管即刻(T3)、插管后5 min(T4)、插管后10 min(T5)、手术切皮时(T6)、切皮后15 min(T7)、切皮后30 min(T8)、切皮后45 min(T9)、切皮后60 min(T10)、切皮后75 min(T11)、切皮后90 min(T12)等不同时相点血流动力学指标,包括收缩压(SBP)、平均动脉压(MAP)、舒张压(DBP)、心率(HR)等;记录3组不良反应发生情况。结果与T0基础参数比较,在T3、T6时各组都出现了血流动力学波动,其中空白对照组波动范围最大,试验组波动范围最小(P<0.05)。在T7-T12点,全程输注组出现较大范围的血流动力学波动,其中T12时相点波动范围最大;试验组波动范围最小(P<0.05)。试验组不良反应发生率低于其他两组(P<0.05)。结论DEX诱导前输注有利于维持血流动力学的稳定,全程静脉输注DEX易引起术终患者血流动力学波动。

Objective To investigate the effects of prior-to-induction infusion vs whole-process infusion of dexmedetomidine(DEX)on hemodynamics of patients.Methods Ninety patients,who underwent elective surgery under general anesthesia with tracheal intubation at Guangzhou Medical University Hospital of Traditional Chinese Medicine between December 2019 and June 2020,were included as subjects and were randomly divided into the blank control group(given intravenous infusion of normal saline at a background dose of 0.5μg/kg for 10 min prior to induction,followed by a dose of 0.5μg·kg^(-1)·h^(-1) until the end of the operation),the study group(given pumping of DEX 0.5μg/kg for 10 min prior to induction,followed by drug discontinuation),and whole-process infusion group(given pumping of DEX 0.5μg/kg for 10 min prior to induction,followed by DEX infusion at a dose of 0.5μg·kg^(-1)·h^(-1)until the end of the operation).At various time points,ie.Before DEX use(T0),completion of intravenous DEX bolus(T1),before endotracheal intubation(T2),immediately after intubation(T3),5 min after intubation(T4),10 min after intubation(T5),at skin incision(T6),15 min after skin incision(T7),30 min after skin incision(T8),45 min after skin incision(T9),60 min after skin incision(T10),75 min after skin incision(T11)and 90 min after skin incision(T12),the three groups were observed for hemodynamic indicators,including systolic blood pressure(SBP),mean arterial pressure(MAP),diastolic blood pressure(DBP),and heart rate(HR).Adverse reactions in the three groups were also recorded.Results Compared with the baseline data at T0,hemodynamic fluctuations were seen in all groups at T3 and T6,with greatest excursion in the blank control group and minimal changes in the study group(P<0.05).At T7 through T12,the whole-process infusion group showed a large excursion in hemodynamic fluctuations,which was most prominent at T12;the study group showed milder fluctuations at these time points(P<0.05).The incidence of adverse reactions was lower in the study group than that in the other two groups(P<0.05).Conclusion Infusion of DEX prior to induction is conducive for maintenance of hemodynamic stability.In comparison,whole-process intravenous infusion of DEX is readily to cause hemodynamic fluctuations in patients at the end of surgery.