右美托咪定对2型糖尿病患者全麻诱导期QTc及Tp-e间期的影响

发布时间：2018-04-26 00:36

本文选题：右美托咪定 + 糖尿病　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:观察右美托咪定对2型糖尿病患者全麻诱导期QTc及Tp-e间期的影响,为糖尿病患者麻醉提供临床参考。方法:60例拟行择期手术的2型糖尿病全麻患者,糖尿病病程大于1年,ASA分级Ⅰ~Ⅱ级,年龄40~70岁,体重指数(BMI)18~30 kg/m2,术前空腹血糖浓度≤11.2 mmol/L。随机分为两组,对照组(C组,n=30)和右美托咪定组(D组,n=30)。D组在麻醉诱导前10分钟静脉泵注右美托咪定(DEX)负荷量0.5 ug/kg,之后以0.4 ug·kg-1·h-1持续泵注至气管插管后3 min,C组用等剂量生理盐水以同样方法泵注。监测两组患者入室静息后(T0)、诱导后插管前(T1)、插管后1 min(T2)、插管后2 min(T3)及插管后3 min(T4)时两组患者心率(HR)、平均动脉压(MAP),记录并分析心电图QTc间期及Tp-e间期的变化。结果:(1)QTc间期及Tp-e间期:与T0比较,D组T1-T4时点QTc间期及Tp-e间期差异无统计学意义(P0.05);C组在T2时点QTc间期显著延长(P0.05),Tp-e间期在T1及T4时点显著延长(P0.05)。与C组比较,D组T1、T2及T4时点QTc间期差异有统计学意义(P0.05);D组T1-T4时点Tp-e间期均明显低于C组(P0.05)。两组QTc间期及Tp-e间期值均在气管插管后3 min逐渐恢复到基础值左右。(2)血流动力学:与T0相比,D组T1、T3及T4时点HR显著降低,差异有统计学意义(P0.05);D组T1-T4时点MAP均显著降低(P0.05)。与T1比较,D组T2、T3时点HR显著升高(P0.05);D组T2-T4时点MAP显著升高(P0.05)。与T0相比,C组T1、T2及T4时点HR差异有统计学意义(P0.05);C组MAP在T1、T3及T4时点均显著降低(P0.05)。与T1相比,C组T2-T4时点HR均显著升高(P0.05);C组T2-T3时点MAP显著升高(P0.05)。与C组相比,D组T2点HR及MAP均显著降低,差异有统计学意义(P0.05)。结论:糖尿病患者全麻诱导期给予右美托咪定能够有效的抑制患者气管插管反应,维持血流动力学稳定;诱导期使用右美托咪定能够缩短全麻诱导期的QTc间期及Tp-e间期延长,降低发生严重心律失常的风险。
[Abstract]:Objective: To observe the effect of dexmedetomidin on QTc and Tp-e interval in the induction period of general anesthesia in patients with type 2 diabetes, and to provide clinical reference for the anaesthesia of diabetic patients. Methods: 60 patients with type 2 diabetic general anesthesia which were planned to undergo elective surgery, the course of diabetes was more than 1 years, ASA grade I ~ II, 40~70 years old, BMI 18~30 kg/m2, and preoperative fasting blood. The glucose concentration was less than 11.2 mmol/L. and divided into two groups randomly. The control group (group C, n=30) and right metoimidin group (group D, n=30).D were injected right metodetonidine (DEX) load 0.5 ug/kg for 10 minutes before induction of anesthesia, followed by 0.4 UG kg-1 H-1 continuous pump to 3 min after endotracheal intubation. The group was pumped with equal dose of saline for the same method. Monitoring two Group patients after resting (T0), pre intubation (T1), 1 min (T2) after intubation, 2 min (T3) after intubation and 3 min (T4) after intubation, two groups of patients' heart rate (HR) and mean arterial pressure (MAP), recorded and analyzed the changes in the QTc interval and interval of the ECG. There was no statistical significance (P0.05) in group C (P0.05) at the time point of T2, and a significant extension of Tp-e interval at T1 and T4 time points (P0.05). Compared with the C group, there was a significant difference between the D group T1, the interval and the time point. The interval and interval value of the two groups were both at 3 after endotracheal intubation. Min gradually recovered to the base value. (2) hemodynamic: compared with T0, T1, T3 and T4 at the time point of group D decreased significantly, and the difference was statistically significant (P0.05). The T1-T4 point MAP of D group decreased significantly (P0.05). The difference was statistically significant (P0.05), and the time point of T1, T3 and T4 decreased significantly in group C (P0.05). Compared with T1, T2-T4 point HR increased significantly (P0.05) in C group (P0.05). Imidin can effectively inhibit the patient's tracheal intubation response and maintain hemodynamic stability. The use of dexmedetomidine in the induction period can shorten the QTc interval and Tp-e interval in the induction period of general anesthesia, and reduce the risk of serious arrhythmia.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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