不同剂量右美托咪定对全身麻醉患者围术期心肌细胞电生理的影响

Effects of different doses of dexmedetomidine on perioperative cardiomyocyte electrophysiology in patients under general anesthesia

目的研究全身麻醉患者行不同剂量右美托咪定对其围术期心肌细胞电生理的影响。方法以回顾性分析为研究方法,观察对象为2020年1月至2022年1月入玉林市红十字会医院的162例全身麻醉手术患者,根据麻醉方式不同分为A组(n=40)、B组(n=41)、C组(n=41)和D组(n=40)。A组右美托咪定负荷剂量、维持剂量分别为1μg/kg、1μg·kg^(-1)·h^(-1);B组右美托咪定负荷剂量、维持剂量分别为1μg/kg、0.5μg·kg^(-1)·h^(-1);C组右美托咪定负荷剂量、维持剂量分别为0.5μg/kg、0.5μg·kg^(-1)·h^(-1);D组0.9%氯化钠溶液负荷剂量50 mL/h,持续性输注10 min,维持剂量10 mL/h。于右美托咪定或0.9%氯化钠溶液使用前(T_(1))、负荷剂量完成(T_(2))、手术完成即刻(T_(3))、入麻醉后监测治疗室(PACU)后1 h(T_(4))、术后1 d(T_(5))、术后2 d(T_(6))、术后3 d(T_(7))、术后1个月(T_(8)),采集4组患者的12导联心电图,记录QTc间期,并计算心脏电生理平衡指数(iCEB)。比较4组患者手术指标与不同时间点的QRS、PR、QTc及Tp-e间期和iCEB。结果4组患者麻醉时间、手术时间、呼之睁眼时间、术中及PACU内液体总入量比较,差异均无统计学意义(P>0.05)。4组患者T_(1)、T_(2)、T_(3)、T_(4)、T_(5)、T_(6)、T_(7)、T_(8)时QRS间期比较,差异均无统计学意义(P>0.05)。A、C组T_(2)、T_(3)、T_(4)时PR间期较T_(1)时明显延长,B组T_(2)时PR间期较T_(1)时明显延长,C组T_(7)时PR间期较T_(1)时明显缩短,A、B组T_(5)、T_(6)、T_(7)、T_(8)时PR间期较T_(2)时明显缩短,C组T_(6)、T_(7)、T_(8)时PR间期较T_(2)时明显缩短,A组、B组T_(2)时PR间期较C组明显延长,差异均有统计学意义(P<0.05)。A、B组T_(2)时QTc间期较D组明显延长,C组T_(4)、T_(5)时QTc间期较D组明显缩短,C组T_(2)、T_(3)、T_(4)、T_(6)、T_(7)时QTc间期较A组明显缩短,C组T_(2)时QTc间期较B组明显缩短,差异均有统计学意义(P<0.05)。A组T_(5)时Tp-e间期较D组明显延长,C组T_(5)时Tp-e间期较D组明显缩短,C组T_(4)、T_(5)、T_(6)时Tp-e间期较A组明显缩短,C组T_(5)、T_(6)时Tp-e间期较B组明显缩短,差异均有统计学意义(P<0.05)。C组T_(5)时iCEB较A、B、D组明显降低,差异均有统计学意义(P<0.05)。结论全身麻醉术中静脉注射右美托咪定负荷剂量、维持剂量分别为0.5μg/kg、0.5μg·kg^(-1)·h^(-1)时对稳定患者围术期心肌细胞电生理的效果最为显著。

Objective To study the effect of different doses of dexmedetomidine on the electrophysiology of cardiomyocytes in patients with general anesthesia during perioperative period.Methods A total of 162 patients undergoing general anesthesia in Yulin Red Cross Hospital from January 2020 to January 2022 were enrolled in this study.According to the anesthesia method,they were divided into group A(n=40),group B(n=41),group C(n=41)and group D(n=40).The loading dose and maintenance dose of dexmedetomidine in group A were 1μg/kg and 1μg·kg^(-1)·h^(-1),respectively.The loading dose and maintenance dose of dexmedetomidine in group B were 1μg/kg and 0.5μg·kg^(-1)·h^(-1),respectively.The loading dose and maintenance dose of dexmedetomidine in group C were 0.5μg/kg and 0.5μg·kg^(-1)·h^(-1),respectively.In group D,the loading dose of normal saline was 50 mL/h,continuous infusion was 10 min,and the maintenance dose was 10 mL/h.Twelve lead electrocardiograms and QTc intervals in four groups of patients:before use of dexmedetomidine or 0.9%sodium chloride solution(T_(1)),after completion of loading dose(T_(2)),immediately after surgery(T_(3)),1 hour after postanesthesia care unit(PACU)(T_(4)),1 day after surgery(T_(5)),2 days after surgery(T_(6)),3 days after surgery(T_(7)),and 1 month after surgery(T_(8))were collected.The QRS,PR,QTc,Tp-e interval and iCEB of the four groups were compared at different time points.Results There were no statistically significant differences in the anesthesia time,surgical time,eye opening time during exhalation,and total fluid intake during surgery and PACU among the four groups of patients(P>0.05).There were no statistically significant differences in QRS interval at T_(1),T_(2),T_(3),T_(4),T_(5),T_(6),T_(7),and T_(8)among the four groups(P>0.05).PR interval at T_(2),T_(3)and T_(4)in groups A and C were significantly longer than those at T_(1),PR interval at T_(2)in group B was significantly longer than that at T_(1),PR interval at T_(7)in group C was significantly shorter than that at T_(1),PR interval at T_(5),T_(6),T_(7)and T_(8)in groups A and B were significantly shorter than those at T_(2),PR interval at T_(6),T_(7)and T_(8)in group C were significantly shorter than that at T_(2).The PR interval at T_(2)in groups A and B were significantly longer than that in group C,and the differences were statistically significant(P<0.05).The QTc interval at T_(2)in groups A and B were significantly longer than that in group D,the QTc interval at T_(4)and T_(5)in group C were significantly shorter than those in group D,the QTc interval at T_(2),T_(3),T_(4),T_(6)and T_(7)in group C were significantly shorter than those in group A,and the QTc interval at T_(2)in group C was significantly shorter than that in group B,and the differences were statistically significant(P<0.05).The Tp-e interval at T_(5)in group A was significantly longer than that in group D,the Tp-e interval at T_(5)in group C was significantly shorter than that in group D,the Tp-e interval at T_(4),T_(5)and T_(6)in group C were significantly shorter than those in group A,and the Tp-e interval at T_(5)and T_(6)in group C were significantly shorter than those in group B,the differences were statistically significant(P<0.05).The iCEB of group C was significantly lower than those of groups A,B and D at T_(5),and the differences were statistically significant(P<0.05).Conclusion The loading dose and maintenance dose of dexmedetomidine during general anesthesia are 0.5μg/kg and 0.5μg·kg^(-1)·h^(-1)respectively,which have the most significant effect on cardiomyocyte electrophysiology in stable patients during perioperative period.