CAJ | 학술논문

目的评价右美托咪定对快室率心房颤动患者行非心脏手术时麻醉诱导期血流动力学的影响.方法行择期手术的风湿性心脏瓣膜病并发快室率心房颤动患者50例,性别不限,年龄45～64岁,体重50 ～ 75kg,心室率≥90次/min,ASA分级Ⅱ或Ⅲ级,NYHA分级Ⅱ或Ⅲ级.采用随机数字表法,将其分为2组(n=25):对照组(C组)和右美托咪定组(D组).D组于常规麻醉诱导前10min静脉输注右美托咪定0.6 μg/kg.常规麻醉诱导:静脉注射咪达唑仑0.06 mg/kg、舒芬太尼0.6 μg/kg和维库溴铵0.12 mg/kg,当BIS值≤55时行气管插管.分别于入室后(T0)、右美托咪定输注停止后即刻(T1)、气管插管前即刻(T2)、气管插管后1、3、5 min(T3-5)时记录SP、DP、MAP及HR,同时记录麻醉,诱导至气管插管后5 min内心血管事件的发生情况.结果与T0时比较,C组HR T2,5时降低,T3,4时升高,D组HR T1-5时降低;C组SP、DP及MAP T2,5时降低,T3时升高(P＜0.05或0.01),D组上述指标差异无统计学意义(P＞0.05);与C组比较,D组低血压、高血压和心动过速的发生率降低(P＜0.05),心动过缓发生率差异无统计学意义(P＞0.05).结论静脉输注右美托咪定0.6μg/kg有助于维持快室率心房颤动患者行非心脏手术时麻醉诱导期血流动力学稳定.
목적 평개우미탁미정대쾌실솔심방전동환자행비심장수술시마취유도기혈류동역학적영향.방법 행택기수술적풍습성심장판막병병발쾌실솔심방전동환자50례,성별불한,년령45～64세,체중50 ～ 75kg,심실솔≥90차/min,ASA분급Ⅱ혹Ⅲ급,NYHA분급Ⅱ혹Ⅲ급.채용수궤수자표법,장기분위2조(n=25):대조조(C조)화우미탁미정조(D조).D조우상규마취유도전10min정맥수주우미탁미정0.6 μg/kg.상규마취유도:정맥주사미체서륜0.06 mg/kg、서분태니0.6 μg/kg화유고추안0.12 mg/kg,당BIS치≤55시행기관삽관.분별우입실후(T0)、우미탁미정수주정지후즉각(T1)、기관삽관전즉각(T2)、기관삽관후1、3、5 min(T3-5)시기록SP、DP、MAP급HR,동시기록마취,유도지기관삽관후5 min내심혈관사건적발생정황.결과 여T0시비교,C조HR T2,5시강저,T3,4시승고,D조HR T1-5시강저;C조SP、DP급MAP T2,5시강저,T3시승고(P＜0.05혹0.01),D조상술지표차이무통계학의의(P＞0.05);여C조비교,D조저혈압、고혈압화심동과속적발생솔강저(P＜0.05),심동과완발생솔차이무통계학의의(P＞0.05).결론 정맥수주우미탁미정0.6μg/kg유조우유지쾌실솔심방전동환자행비심장수술시마취유도기혈류동역학은정.
Objective To evaluate the effects of dexmedetomidine on hemodynamics during induction of anesthesia in the patients with atrial fibrillation with rapid ventricular rate undergoing noncardiac surgery.Methods Fifty patients with rheumatic valvular heart disease complicated with atrial fibrillation,aged 45-64 yr,weighing 50-75 kg,with ventricular rate ≥ 90 bpm,of ASA physical status Ⅱ or Ⅲll (NYHA Ⅱ or Ⅲ),scheduled for elective surgery,were randomly divided into 2 groups (n =25 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Dexmedetomidine 0.6 μg/kg was infused intravenously at 10 min prior to induction of anesthesia in group D.Anesthesia was induced with iv midazolam 0.06 mg/kg,sufentanil 0.6 μg/kg,and vecuronium 0.12 mg/kg.Tracheal intubation was performed when the BIS value≤≤ 55After admission to operating room (T0,baseline),immediately after the end of dexmedetomidine infusion (T1),immediately before intubation (T2),and at 1,3 and 5 min after intubation (T3-5),SP,DP,MAP and HR were recorded.The adverse cardiovascular events were recorded starting from induction of anesthesia to 5 min after intubation.Results Compared with the baseline value at T0,HR was significantly decreased at T2,5,while increased at T3,4 in group C,and HR was decreased at T1-5 in group D; SP,DP and MAP were decreased at T2,5,while increased at T3 in group C,and no significant changes were found in the indices mentioned above in group D.Compared with group C,the incidence of hypotension,hypertension and tachycardia was significantly decreased,and no significant changes were found in theincidence of bradycardia in group D.Conclusion Dexmedetomidine 0.6 μg/kg infused intravously is helpful in maintaining the hemadynamics stable during induction of anesthesia in the patients with atrial fibrillation with rapid ventricular rate underging noncardiac surgery.