目的 观察新型肾上腺素受体激动剂右美托咪定(dexmedetomidine,Dex)预注对瓣膜置换术患者麻醉诱导期血流动力学和脑电双频指数(bispectral index,BIS)值的影响. 方法 选择择期瓣膜置换术患者30例,采用随机数字表法分为两组:Dex组(D组)和对照组(C组),每组15例.D组于麻醉诱导前静脉微量泵预注用生理盐水稀释成50 ml的Dex(浓度为4 mg/L)0.5 μg/kg,输注时间为10 min,C组以同样方式输注等体积生理盐水.均以依托咪脂、芬太尼、哌库溴铵、咪达唑仑复合诱导麻醉.记录入室后输注Dex前即刻基础值(T1)、输注Dex后5 min(T2)、输注Dex后10 min麻醉诱导前时刻(T3)、麻醉诱导后1 min(T4)、麻醉诱导后3 min(T5)、插管前即刻(T6)、插管即刻(T7)、插管后1 min(T8)、插管后3 min(T9)、插管后5 min(T10)各时点的心率(heart rate,HR)、有创血压值(arterial blood pressure,ABP)[收缩压(systolic blood pressure,SBP)、舒张压(diastolicblood pressure,DBP)、平均动脉压(mean artery pressure,MAP)]和BIS变化. 结果 全麻诱导前,与T1(92.6±2.5)比较,D组BIS在T2(73.2±1.9)、T3(70.1±2.3)时显著下降(P＜0.05或P＜0.01),C组没有明显变化;全麻诱导期,与T3比较,两组BIS明显下降;气管插管期间,与T6比较,C组在T7时BIS(34.8±2.2)显著增高(P＜0.05或P＜0.01),而D组BIS无明显变化.与C组比较,D组BIS在T2～T5、T7明显降低(P＜0.05或P＜0.01).全麻诱导前,与T1比较,D组在T2、T3时ABP略有增高,HR显著降低(P＜0.05或P＜0.01);全麻诱导期,与T3比较,两组ABP、HR均下降;气管插管期间,与T6比较,D组DBP、MAP、HR在T7、T8略有升高,T9、T10无明显变化(P＞0.05),C组ABP、HR在T7～T10显著增高(P＜0.05或P＜0.01).与C组比较,D组SBP、MAP在T4～T10和DBP在T3～T10显著增高、HR在T2～T10显著降低(P＜0.05或P＜0.01). 结论 静脉预注Dex能明显加深麻醉,BIS降低,减少瓣膜置换术患者气管内插管期心血管反应,血流动力学更加平稳,适合在临床中应用.
目的 觀察新型腎上腺素受體激動劑右美託咪定(dexmedetomidine,Dex)預註對瓣膜置換術患者痳醉誘導期血流動力學和腦電雙頻指數(bispectral index,BIS)值的影響. 方法 選擇擇期瓣膜置換術患者30例,採用隨機數字錶法分為兩組:Dex組(D組)和對照組(C組),每組15例.D組于痳醉誘導前靜脈微量泵預註用生理鹽水稀釋成50 ml的Dex(濃度為4 mg/L)0.5 μg/kg,輸註時間為10 min,C組以同樣方式輸註等體積生理鹽水.均以依託咪脂、芬太尼、哌庫溴銨、咪達唑崙複閤誘導痳醉.記錄入室後輸註Dex前即刻基礎值(T1)、輸註Dex後5 min(T2)、輸註Dex後10 min痳醉誘導前時刻(T3)、痳醉誘導後1 min(T4)、痳醉誘導後3 min(T5)、插管前即刻(T6)、插管即刻(T7)、插管後1 min(T8)、插管後3 min(T9)、插管後5 min(T10)各時點的心率(heart rate,HR)、有創血壓值(arterial blood pressure,ABP)[收縮壓(systolic blood pressure,SBP)、舒張壓(diastolicblood pressure,DBP)、平均動脈壓(mean artery pressure,MAP)]和BIS變化. 結果 全痳誘導前,與T1(92.6±2.5)比較,D組BIS在T2(73.2±1.9)、T3(70.1±2.3)時顯著下降(P＜0.05或P＜0.01),C組沒有明顯變化;全痳誘導期,與T3比較,兩組BIS明顯下降;氣管插管期間,與T6比較,C組在T7時BIS(34.8±2.2)顯著增高(P＜0.05或P＜0.01),而D組BIS無明顯變化.與C組比較,D組BIS在T2～T5、T7明顯降低(P＜0.05或P＜0.01).全痳誘導前,與T1比較,D組在T2、T3時ABP略有增高,HR顯著降低(P＜0.05或P＜0.01);全痳誘導期,與T3比較,兩組ABP、HR均下降;氣管插管期間,與T6比較,D組DBP、MAP、HR在T7、T8略有升高,T9、T10無明顯變化(P＞0.05),C組ABP、HR在T7～T10顯著增高(P＜0.05或P＜0.01).與C組比較,D組SBP、MAP在T4～T10和DBP在T3～T10顯著增高、HR在T2～T10顯著降低(P＜0.05或P＜0.01). 結論 靜脈預註Dex能明顯加深痳醉,BIS降低,減少瓣膜置換術患者氣管內插管期心血管反應,血流動力學更加平穩,適閤在臨床中應用.
목적 관찰신형신상선소수체격동제우미탁미정(dexmedetomidine,Dex)예주대판막치환술환자마취유도기혈류동역학화뇌전쌍빈지수(bispectral index,BIS)치적영향. 방법 선택택기판막치환술환자30례,채용수궤수자표법분위량조:Dex조(D조)화대조조(C조),매조15례.D조우마취유도전정맥미량빙예주용생리염수희석성50 ml적Dex(농도위4 mg/L)0.5 μg/kg,수주시간위10 min,C조이동양방식수주등체적생리염수.균이의탁미지、분태니、고고추안、미체서륜복합유도마취.기록입실후수주Dex전즉각기출치(T1)、수주Dex후5 min(T2)、수주Dex후10 min마취유도전시각(T3)、마취유도후1 min(T4)、마취유도후3 min(T5)、삽관전즉각(T6)、삽관즉각(T7)、삽관후1 min(T8)、삽관후3 min(T9)、삽관후5 min(T10)각시점적심솔(heart rate,HR)、유창혈압치(arterial blood pressure,ABP)[수축압(systolic blood pressure,SBP)、서장압(diastolicblood pressure,DBP)、평균동맥압(mean artery pressure,MAP)]화BIS변화. 결과 전마유도전,여T1(92.6±2.5)비교,D조BIS재T2(73.2±1.9)、T3(70.1±2.3)시현저하강(P＜0.05혹P＜0.01),C조몰유명현변화;전마유도기,여T3비교,량조BIS명현하강;기관삽관기간,여T6비교,C조재T7시BIS(34.8±2.2)현저증고(P＜0.05혹P＜0.01),이D조BIS무명현변화.여C조비교,D조BIS재T2～T5、T7명현강저(P＜0.05혹P＜0.01).전마유도전,여T1비교,D조재T2、T3시ABP략유증고,HR현저강저(P＜0.05혹P＜0.01);전마유도기,여T3비교,량조ABP、HR균하강;기관삽관기간,여T6비교,D조DBP、MAP、HR재T7、T8략유승고,T9、T10무명현변화(P＞0.05),C조ABP、HR재T7～T10현저증고(P＜0.05혹P＜0.01).여C조비교,D조SBP、MAP재T4～T10화DBP재T3～T10현저증고、HR재T2～T10현저강저(P＜0.05혹P＜0.01). 결론 정맥예주Dex능명현가심마취,BIS강저,감소판막치환술환자기관내삽관기심혈관반응,혈류동역학경가평은,괄합재림상중응용.
Objective To evaluate the influence of dexmedetomidine(Dex)(highly selective α2-adrenergic receptor agonist) on haemodynamics and bispectral index (BIS) during anesthetic induction in patients undergoing valve replacement surgery.Methods Thirty NYHA class Ⅱ or Ⅲ patients,aged between 30 y and 70 y,undergoing cardiac value replacement with cardiopulmonary bypass,were randomly divided into two groups (n=15):Dex group(group D) and control group(group C).In group Dex,pump diluted with saline to 50 ml of Dex (4 mg/L)0.5 μg/kg was administered iv 10 min before the induction of anesthesia,while in group C,same volume of 0.9％ normal saline was given.The patients were premedicated with intramuscular morphine and scopolamine.Anesthesia was induced with 0.06 mg/kg,fentanyl 6 μg/kg,etomidate 0.3 mg/kg and pipecuronium 0.10 mg/kg.Anesthesia was maintained with midazolam,fentanyl,intermittently.In two group,heart rate(HR),arterial blood pressure(ABP)[systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)] and bispectral index(BIS) were recorded at the time before Dex infusion(T1),5 min after loading dose(T2),10 min after loading dose(T3),1,3 min after anesthesia induction(T4,T5),just before endotracheal intubation(T6),endotracheal intubation(T7) and 1,3,5 min after endotracheal intubation(T8-10).Results BIS of T2,T3 in group D was decreased significantly [from(92.6±2.5) to (73.2±1.9) and (70.1±2.3)](P＜0.05 or P＜0.01) compared with T1.During anesthesia induction compared with T3,BIS in both groups were decreased significantly.During endotracheal intubation compared with T6,BIS of T7 (34.8±2.2) was increased significantly in group C(P＜0.05 or P＜0.01),while BIS in group C were similar to the initial values.Compared with group C,BIS decreased significantly at time T2～5、T7 in group D (P＜0.05 or P＜0.01).Before anesthesia induction compared with T1,ABP of T2、T3 in group D was increased slightly,HR of T2、T3 was decreased significantly (P＜0.05 or P＜0.01); During anesthesia induction compared with T3,ABP and HR in both groups were decreased significantly.Compared with T6,DBP,MAP and HR of T7,T8 were increased slightly,that of T9,T10 were similar to the values in group D.During endotracheal intubation,while ABP and HR of T7-T1o was increased significantly in group C (P＜0.05 or P＜0.01).Compared with group C,SBP,MAP of T4-T10 and DBP of T3-T10 were increased significantly in group D.HR of T2-T10 were decreased significantly in group D (P＜0.05 or P＜0.01).Conclusions Dex pretreatment might decrease BIS and alleviate haemodynamics reaction during anesthetic induction in patients undergoing valve replacement surgery with cardiopulmonary bypass.
