右美托咪定对主动脉瓣置换术后患者心率变异性的影响

Effect of dexmedetomidine on heart rate variability in patients after aortic valve replacement

目的:探讨右美托咪定对主动脉瓣置换术(AVR)后患者心率变异性(HRV)的影响。方法:本研究为回顾性病例对照研究,选取2020年1月至2023年4月北部战区总医院心血管外科收治的130例行AVR的主动脉瓣病变患者,男74例,女56例,年龄(58.07±9.38)岁,年龄范围为28~74岁。通过患者使用右美托咪定的情况,将患者分为A组、B组和C组,A组为未使用右美托咪定( n=63),B组为右美托咪定按需给药(因患者术后出现失眠、口服镇痛未减缓疼痛等原因,给予次数不大于6次, n=38),C组为右美托咪定按疗程给药(术后应用药物次数大于6次, n=29)。比较三组患者围术期7 d的心率、心房颤动发生率、左室射血分数指标。比较三组患者术前和术后的HRV指标,包括连续RR间隔相差大于50 ms的百分比、R波时间间隔的方均根、窦性心搏RR间期的标准差(SDNN)、24 h记录的所有5 min段中NN间隔的标准偏差的平均值(SDNNIDX)、RR间期的平均值标准差(SDANN)、连续RR间隔相差大于20 ms的百分比。 结果:三组患者术后7 d的SDNN[A组53.40(49.40,66.10)ms,B组62.70(54.68,73.68)ms,C组62.50(50.80,78.15)ms]、SDANN[A组(51.80±11.42)ms,B组(60.96±14.88)ms,C组(60.06±16.01)ms]、SDNNIDX[A组(17.55±5.35)ms,B组(21.49±7.56)ms,C组(19.08±5.62)ms]比较,差异有统计学意义( P<0.05)。B组与C组比较,当患者术后应激症状较大时给药,会使得SDNN、SDNNIDX与SDANN下降趋势更大,对患者HRV影响更大;而对于C组患者而言,即使药量增加,SDNNIDX、SDNN与SDANN的下降趋势也较缓和。 结论:AVR后应用右美托咪定对患者的SDNN、SDNNIDX、SDANN均有作用,按疗程给药的患者虽然使用剂量增加但上述指标术后下降趋势更缓和。

ObjectiveTo investigate the effect of dexmedetomidine on heart rate variability(HRV)after aortic valve replacement(AVR).MethodsA retrospective case-control study was conducted,a total of 130 patients with AVR aortic valve disease were selected from the department of Cardiovascular Surgery in General Hospital of Northern Theater Command from January 2020 to April 2023,there were 74 males and 56 females,aged(58.07±9.38)years old,ranging from 28 to 74 years old.The patients were divided into A group,B group and C group according to the use of dexmedetomidine.A group was not treated with dexmedetomidine(n=63),B group was given dexmedetomidine on demand(n=38),and C group was routinely given dexmedetomidine according to the course of treatment(n=29).The perioperative heart rate,incidence of atrial fibrillation and left ventricular ejection fraction were compared among the 3 groups.The HRV indexes of the 3 groups were compared before and after operation,including the percentage of successive RR intervals that difer by more than 50 ms,root mean square of successive differences,standard deviation of NN intervals(SDNN),mean of the standard deviations of all NN intervals for all 5-minute segments of the entire recording(SDNNIDX),standard deviation of the averages of NN intervals in all 5-minute segments of the entire recording(SDANN),percentage of successive RR intervals that difer by more than 20 ms.ResultsOn the 7 days after operation,SDNN[A group 53.40(49.40,66.10)ms,B group 62.70(54.68,73.68)ms,C group 62.50(50.80,78.15)ms],SDANN[A group(51.80±11.42)ms,B group(60.96±14.8)ms,C group(60.06±16.01)ms],SDNNIDX[A group(17.55±5.35)ms,B group(21.49±7.56)ms,C group(19.08±5.62)ms],the differences were statistically significant(P<0.05).Compared with group C,when patients in group B had severe stress symptoms,the decrease of SDNN,SDNNIDX and SDANN was greater,and the impact on HRV was greater,while for patients in group C,the decreasing trend of SDNNIDX,SDNN and SDANN were moderate even with the increase of drug dosage.ConclusionsDexmedetomidine has an effect on SDNN,SDNNIDX and SDANN of patients after AVR.Although the dose of patients given according to the course of treatment increases,the decline trend of above-mentioned indexes is more moderate after operation.