不同剂量氢吗啡酮对手术患者心脏电生理指标的影响

Effects of different doses of hydromorphone on cardiac electrophysiological indexes in patients undergoing surgery

目的观察不同剂量氢吗啡酮对手术患者心脏电生理指标的影响。方法选择行择期手术、美国麻醉师协会(ASA)分级Ⅰ或Ⅱ级的患者75例,随机均分为H_(1)组(静脉注射氢吗啡酮1.0 mg)、H_(2)组(静脉注射氢吗啡酮1.5 mg)及对照组(注射等量生理盐水),收集3组患者术前性别、ASA分级、年龄、体质量指数(BMI)等一般资料;分别于注射前(T_(1))、注射后15 min(T_(2))及30 min(T_(3))时,采用12导联同步心电图仪检测3组患者的平均动脉压(MAP)、心率(HR)、校正QT间期(QTc)、T波峰-末间期(Tp-e)及Tp-e/QTc比值。结果3组患者不同时点MAP、HR比较,差异无统计学意义(P>0.05);与T_(1)比较,T_(2-3)时H_(2)组患者Tp-e缩短,T_(3)时H_(2)组患者Tp-e/QTc减小(P<0.05);与H_(1)组比较,H_(2)组T_(2-3)时Tp-e缩短、T_(3)时Tp-e/QTc减小(P<0.05)。结论静脉注射氢吗啡酮1.0和1.5 mg用于手术患者超前镇痛,对患者心室复极无影响,不增大心肌复极异质性,心律失常发生风险低。

Objective To observe the effects of different doses of hydromorphone on cardiac electrophysiological indexes in patients undergoing surgery.Methods Seventy-five patients who underwent elective surgery and were classified as ASAⅠor ASAⅡwere selected.They were randomly divided into H_(1) group(receiving an intravenous dose of hydromorphone 1.0 mg),H_(2) group(receiving an intravenous dose of hydromorphone 1.5 mg),and control group(injected with the same amount of normal saline).Preoperative gender,ASA grade,age,Body Mass Index(BMI),and other general data of the 3 groups were collected.Before(T_(1)),15 min(T_(2)),and 30 min(T_(3))after injection,the mean arterial pressure(map),heart rate(HR),corrected QT interval(QTc),T peak-end-interval(Tp-e),and Tp-e/QTc ratio were measured by 12 lead synchronous electrocardiograph.Results There was no significant difference in MAP and HR among 3 groups at different time points(P>0.05);Compared with T_(1),Tp-e in H_(2) group was shortened at T_(2-3),and Tp-e/QTc was decreased in H_(2) group at T_(3)(P<0.05);Compared with H_(1) group,Tp-e shortened at T_(2-3) and Tp-e/QTc decreased at T_(3) in H_(2) group(P<0.05).Conclusion An intravenous dose of hydromorphone 1.0 mg and 1.5 mg for preemptive analgesia in surgical patients,which has no effect on ventricular repolarization,does not increase the heterogeneity of myocardial repolarization,and the risk of arrhythmia is low.