医药前沿
醫藥前沿
의약전연
YIAYAO QIANYAN
2014年
2期
58-59
,共2页
右美托咪定%冠心病%血流动力学%全身麻醉
右美託咪定%冠心病%血流動力學%全身痳醉
우미탁미정%관심병%혈류동역학%전신마취
Dexmedetomidine coronary heart disease%Hemodynamics general anesthesia
目的：探讨右美托咪定对冠心病患者的血流动力学的影响。方法拟在全身麻醉下行骨科手术的冠心病患者70例，年龄55岁-80岁，体重43kg-75kg，ASA Ⅱ～Ⅲ级，心功能Ⅱ～Ⅲ级。采用随机数字表法，将患者随机分为右美托咪定(D组，n=35)和对照组(C组，n=35)。D组在麻醉诱导前10min内静脉泵入负荷剂量右美托咪定0.5μg/kg，继之以0.5μg/(kg·h)持续静脉泵注至手术结束。C组给予等量生理盐水。记录麻醉诱导前（T0）、诱导后即刻(T1)、气管插管后即刻(T2)、切皮时(T3)、拔管后即刻(T4)、拔管后10min(T5)的收缩压（SP）、舒张压(DP)、心率(HR)及心电图ST段水平。结果 T0时两组SP、DP、H R和S T段水平差异无统计学意义（P>0.05）。T1时两组S P、D P、H R均较T0有明显下降( P<0.05)，两组间比较无显著差异( P>0.05)。T2、T3、T4和T5时D组SP、DP、HR均明显低于C组(P<0.05)。各时点ST段均未出现明显的心肌缺血性改变，两组比较无显著差异(P>0.05)。结论右美托咪定可减轻冠心病患者全身麻醉期血流动力学的波动，维持全身麻醉期血流动力学的稳定。
目的：探討右美託咪定對冠心病患者的血流動力學的影響。方法擬在全身痳醉下行骨科手術的冠心病患者70例，年齡55歲-80歲，體重43kg-75kg，ASA Ⅱ～Ⅲ級，心功能Ⅱ～Ⅲ級。採用隨機數字錶法，將患者隨機分為右美託咪定(D組，n=35)和對照組(C組，n=35)。D組在痳醉誘導前10min內靜脈泵入負荷劑量右美託咪定0.5μg/kg，繼之以0.5μg/(kg·h)持續靜脈泵註至手術結束。C組給予等量生理鹽水。記錄痳醉誘導前（T0）、誘導後即刻(T1)、氣管插管後即刻(T2)、切皮時(T3)、拔管後即刻(T4)、拔管後10min(T5)的收縮壓（SP）、舒張壓(DP)、心率(HR)及心電圖ST段水平。結果 T0時兩組SP、DP、H R和S T段水平差異無統計學意義（P>0.05）。T1時兩組S P、D P、H R均較T0有明顯下降( P<0.05)，兩組間比較無顯著差異( P>0.05)。T2、T3、T4和T5時D組SP、DP、HR均明顯低于C組(P<0.05)。各時點ST段均未齣現明顯的心肌缺血性改變，兩組比較無顯著差異(P>0.05)。結論右美託咪定可減輕冠心病患者全身痳醉期血流動力學的波動，維持全身痳醉期血流動力學的穩定。
목적：탐토우미탁미정대관심병환자적혈류동역학적영향。방법의재전신마취하행골과수술적관심병환자70례，년령55세-80세，체중43kg-75kg，ASA Ⅱ～Ⅲ급，심공능Ⅱ～Ⅲ급。채용수궤수자표법，장환자수궤분위우미탁미정(D조，n=35)화대조조(C조，n=35)。D조재마취유도전10min내정맥빙입부하제량우미탁미정0.5μg/kg，계지이0.5μg/(kg·h)지속정맥빙주지수술결속。C조급여등량생리염수。기록마취유도전（T0）、유도후즉각(T1)、기관삽관후즉각(T2)、절피시(T3)、발관후즉각(T4)、발관후10min(T5)적수축압（SP）、서장압(DP)、심솔(HR)급심전도ST단수평。결과 T0시량조SP、DP、H R화S T단수평차이무통계학의의（P>0.05）。T1시량조S P、D P、H R균교T0유명현하강( P<0.05)，량조간비교무현저차이( P>0.05)。T2、T3、T4화T5시D조SP、DP、HR균명현저우C조(P<0.05)。각시점ST단균미출현명현적심기결혈성개변，량조비교무현저차이(P>0.05)。결론우미탁미정가감경관심병환자전신마취기혈류동역학적파동，유지전신마취기혈류동역학적은정。
Objective To investigate the influence of dexmedetomidine applied in coronary heart disease on hemodynamics change during general anesthesia.Methods 60 patients with coronary heat disease(ASA Ⅱ~Ⅲ,NYHAⅡ~Ⅲ),who needed orthopedic operation under general anesthesia, were randomly divided into dexmedetomidine group(group D, n=35) and control group(group C, n=35). The maintainence of anesthesia used by sevoflurane inhalation in both two groups, group D and group C ventilated. Group D and group C respectively received a loading dose of dexmedetomidine and normal saline ten minutes before induction by intravenous infusion at 0.5μg/kg (the duration of infusion was ten minutes) fol owed by continuous intravenous infusion maintenance dose at 0.5 μg/(kgńh). systolic blood pressure ( SBP) ,diastolic blood pressure(DBP) , heart rate (HR) and ST-segment level of electrocardiogram were recorded before induction ( T0), after induction (T1),after intubation (T2) and instant time after cutting skin (T3), instant time after extubation (T4), 10 minutes (T5)after extubation. Results There was no significant difference in SBP、DBP、HR and ST-segment level at T0 both of groups (P>0.05). SBP、DBP、HR at T1 significantly decreased than that at T0 both of groups (P<0.05) but comparison between the two groups had no significant difference(P>0.05). SBP、DBP and HR of D group at T2、T3、T4 and T5 significantly decreased than C group (P<0.05). There was no obvious ischemic change of myocardium at al time points and comparison between the two groups had no significant difference(P>0.05).Conclusion Dexmedetomidine can reduce the fluctuation of hemodynamics and maintain stability of hemodynamics of patients with coronary heart disease during general anesthesia.
