右美托咪定对心脏瓣膜置换术患者麻醉中血流动力学的影响

发布时间：2018-03-27 19:13

本文选题：右美托咪定　切入点：心脏瓣膜置换术　出处：《中国药房》2015年35期

【摘要】：目的:探讨右美托咪定对心脏瓣膜置换术患者麻醉中血流动力学的影响。方法:92例心脏瓣膜置换术患者按随机数字表法分为观察组和对照组,各46例。两组患者均采用咪达唑仑1~2 mg/kg+芬太尼0.05 mg/kg+丙泊酚1~2 mg/kg+顺式阿曲库铵0.15 mg/kg常规麻醉诱导方案。观察组患者在常规麻醉诱导方案基础上加用右美托咪定0.5μg/kg,10 min内静脉泵入,然后以0.4μg/(kg·h)维持麻醉至手术结束;对照组患者在常规麻醉诱导方案基础上给予等量生理盐水静脉泵入。记录两组患者麻醉诱导前(T_0)、给药后5 min(T_1)、麻醉诱导后2 min(T_2)、气管插管成功后1 min(T_3)、气管插管成功后3 min(T_4)、气管插管成功后5 min(T_5)的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)、心输出量(CO)、心指数(CI)、每搏量(SV)、每搏变异度(SVV)水平及T_0、T_1时镇静评分(OAA/S评分),观察两组患者麻醉过程中的不良反应。结果:两组患者T0~T5时SVV水平比较,差异无统计学意义(P0.05);观察组患者T0~T5时SBP、DBP、MAP、HR、CO、CI、SV水平均优于对照组,两组比较差异均有统计学意义(P0.01);两组患者T0时OAA/S评分比较,差异无统计学意义(P0.05),T1时观察组患者OAA/S评分显著降低且低于对照组,差异有统计学意义(P0.01)。两组患者心动过缓、低血压等不良反应发生率比较,差异均无统计学意义(P0.05)。结论:右美托咪定用于心脏瓣膜置换术麻醉能有效降低对患者麻醉诱导期血流动力学的影响,且安全性较好。
[Abstract]:Objective: to investigate the effect of dexmetomidine on hemodynamics in patients undergoing cardiac valve replacement. Methods: 92 patients with valvular replacement were randomly divided into two groups: observation group and control group. 46 patients in each group were treated with midazolam 1 mg/kg fentanyl 0.05 mg/kg propofol 12 mg/kg cis atracurium 0.15 mg/kg routine anesthetic induction regimen, the observation group was treated with dexmetomidine 0.5 渭 g / kg / kg 10 min intravenous infusion on the basis of routine anesthesia induction regimen. The anesthesia was maintained at 0. 4 渭 g/(kg / h until the end of the operation. The patients in the control group were given the same amount of normal saline intravenous infusion on the basis of the routine anesthetic induction scheme. The patients in both groups were recorded before induction of anesthesia, before induction of anesthesia, 5 min after anesthesia induction, 5 min after administration of the drug, 2 min after induction of anesthesia, 2 min after induction of anesthesia, 1 min after successful tracheal intubation, 1 min after successful intubation, 1 min after successful intubation, and 5 min after successful intubation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAPP), heart rate (HRT), cardiac output (COG), cardiac index (CI), variability per stroke (SVV) and sedative score at T0 T1 were observed in both groups. Results: the levels of SVV in T0~T5 were compared between the two groups. There was no significant difference in T0~T5 between the two groups (P 0.05), and the levels of SBP / DBP MAPHRCOI / OAA/S in the observation group were higher than those in the control group, and the differences were statistically significant between the two groups, and the OAA/S scores of the two groups were compared at T0, and compared with that in the control group (P < 0.05), and there was no significant difference between the two groups. The OAA/S score of the observation group was significantly lower than that of the control group, and the difference was statistically significant (P 0.01). The incidence of adverse reactions such as bradycardia and hypotension in the two groups was higher than that in the control group. Conclusion: dexmetomidine used in cardiac valve replacement anesthesia can effectively reduce the hemodynamics of patients during anesthesia induction period, and the safety is good.
【作者单位】：武警广东省总队医院麻醉科;广州医科大学附属第二医院麻醉科;
【分类号】：R614

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