摘要
目的研究右美托咪定(Dex)对老年患者全麻后恢复期心率变异性(HRV)的影响。方法 86例择期全麻下行腹部手术的老年患者(≥65岁),随机均分为Dex组(D组)和对照组(C组)。手术结束前10min(缝皮时)D组以Dex0.5μg/kg稀释至10ml并以恒速10min输注完毕,C组以同样方法输注等容量生理盐水。分别于给药前(T_0)、给药后5min(T_1)、10min(T_2)、拔管时(T_3)、拔管后5min(T_4)、30min(T_5)记录两组患者MAP和HR;并测定血浆肾上腺素(E)、去甲肾上腺素(NE)和皮质醇(Cor)浓度;以频域分析法测定HRV各指标:总功率(TP)、低频功率(LF)、高频功率(HF),同时计算LF/HF。结果 T_2～T_5时C组MAP、E、NE明显高于、HR明显快于T_0时和D组(P<0.05);T_3、T_4时D组Cor明显高于T_0时,且T_2～T_4时C组高于T_0时和D组(P<0.05)。T_2～T_5时TP、LF、HF两组均高于T_0时;D组HF升高更明显,T_3～T_5时C组TP、LF高于D组,T_2～T_4时C组HF明显低于D组,T_2～T_5时C组LF/HF明显高于T_0时和D组(P<0.05)。结论右美托咪定用于老年患者全静脉麻醉恢复期,可有效抑制拔管期应激反应,促进HRV的恢复、改善心脏自主神经的均衡性。
Objective： To evaluate the impact of dexmedetomidine on heart rate variability during anesthesia emergence in elderly patients after total intravenous anesthesia. Methods： 86 Elderly patients（age≥65 years） scheduled for abdomen surgery In total intravenous were randomly divided into receive either dexmedetomidine（Group D） （n=43） or saline placebo （Group C） （n=43） intravenously （i.v.）.The group D received 10 ml infusion that contained 0.5g/kg DEX with constant speed and group C received infusion of normal saline （NS）in ten minutes before the end of surgery.The MAP,heart rate （HR）,total power（TP）,relative low frequency（LF）,relative high frequency （HF）, and the ratio of low frequency to high frequency power ratio （LF/HF）,were recorded before（T（0）） and 5（T1） and 10min（T2）after drug administration,during extubation（T3）, and at 5（T4） and 30min（T5） after extubation.At same time,the blood were taken for analysis of plasma epinephrine（E）,norepinephrine（NE）and cortisol（COR）concentration. Results： Compared before,the MAP,HR,and the concentration of E,NE were no significantly changed in group D ,but that was significantly increased in group C after drug administration. these value in the group C was higher compared with group D,moreovere.The concentration of COR in Group D were significant increased at T3、T4,similarly,it was higher in Group C at T2,T3,T4 Compared T0. However this value in the group D was lower compared with group C.In all groups,the TP,LF,and HF were rised at T2,T3,T4,T5.the TP and LF at T3,T4,T5 was higher,but HF at T2,T3,T4,was lower in group C.In group D,the LF/HF was not significantly changed than T0,but not so In group C. Moreover,the LF/HF was higher In group C.Conclusion：These findings suggest that a single-dose bolus injection of dexmedetomidine before tracheal extubation attenuates airway-circulatory reflexes and promote HRV recovery by improving the autonomic nervous balance during extubation.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2012年第7期661-663,共3页
Journal of Clinical Anesthesiology
