孟勤鳳
[摘要] 目的 探究在糖尿病人全麻誘導(dǎo)期間應(yīng)用右美托咪定對(duì)心率變異性的影響。方法 選取該院2017年1—12月收治的80例糖尿病患者為對(duì)象,實(shí)驗(yàn)組使用右美托咪定麻醉誘導(dǎo);對(duì)照組用等量生理鹽水替代。比對(duì)兩組麻醉效果。結(jié)果 實(shí)驗(yàn)組在負(fù)荷量結(jié)束至插管5 min間HR減緩,MAR降低,與靜息時(shí)相比差異有統(tǒng)計(jì)學(xué)意義(P<0.05);實(shí)驗(yàn)組患在插管后1 minHR減緩,負(fù)荷量結(jié)束時(shí)MAP降低,與對(duì)照組相比差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 在糖尿病患者全麻誘導(dǎo)期間應(yīng)用右美托咪定不會(huì)對(duì)心率變異性造成顯著影響,其影響較小,對(duì)于氣道插管反應(yīng)有一定的抑制作用。
[關(guān)鍵詞] 右美托咪定;糖尿病患者;全麻誘導(dǎo)期間;心率變異性;影響
[中圖分類(lèi)號(hào)] R614 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1672-4062(2018)02(b)-0084-02
Effect of Dexmedetomidine on Heart Rate Variability During Induction of General Anesthesia in Diabetic Patients
MENG Qin-feng
Anesthesiology Department, Linyi Mental Health Center, Linyi, Shandong Province, 276005 China
[Abstract] Objective This paper tries to investigate the effect of dexmedetomidine on heart rate variability during general anesthesia induction in diabetic patients. Methods 80 patients with diabetes in this hospital as subjects from January to December 2017 were selected. The experimental group used dexmedetomidine to induce anesthesia; the control group was replaced with the same amount of normal saline. The anesthetic effects of the two groups were compared. Results In the experimental group, the HR slowed down from the end of the loading to 5 minutes after intubation, and the MAR decreased, which was statistically different from that at rest (P<0.05). The experimental group experienced a slower HR at 1 min after intubation, and decreased MAP at the end of the loading. There was a statistically significant difference compared with the control group (P<0.05). Conclusion The application of dexmedetomidine during the induction of general anesthesia in patients with diabetes will not have a significant effect on heart rate variability, its effect is small, and it has a certain inhibitory effect on airway intubation.
[Key words] Dexmedetomidine; Diabetics; Induction period during general anesthesia; Heart rate variability; Effect
糖尿病患者具有較高機(jī)率并發(fā)神經(jīng)系統(tǒng)、心血管系統(tǒng)等疾病,因此如何有效的抑制全麻誘導(dǎo)期應(yīng)激反應(yīng)成為確保糖尿病患者圍術(shù)期生命體征安全的關(guān)鍵點(diǎn)和重中之重[1]。右美托咪定屬于高選擇性α2腎上腺素能受體激動(dòng)劑,其鎮(zhèn)痛、鎮(zhèn)靜、抗交感神經(jīng)活性及穩(wěn)定圍術(shù)期血流變的作用十分顯著,成為一種在臨床備受關(guān)注的藥物[2]。但是臨床中缺少足夠的報(bào)道以了解右美托咪定對(duì)糖尿病患者心率變異性的影響。該文為探究在糖尿病患者全麻誘導(dǎo)期間應(yīng)用右美托咪定對(duì)心率變異性的影響,于2017年1—12月選取在該院就診的80例糖尿病患者作為研究對(duì)象參與臨床研究,取得滿意結(jié)果?,F(xiàn)詳細(xì)報(bào)道如下。
1 資料與方法
1.1 一般資料
選取在該院就診的80例糖尿病患者作為研究對(duì)象參與臨床研究,根據(jù)抽簽結(jié)果將患者均分為兩組,各40例,實(shí)驗(yàn)組中男性患者22例,女性患者18例,平均年齡為(47.29±10.26)歲,對(duì)照組中男性患者21例,女性患者19例,平均年齡為(46.94±11.05)歲。兩組患者在年齡、性別、病情等方面均差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。所有患者均知曉研究意圖及資料用途。
1.2 研究方法
進(jìn)入手術(shù)室后開(kāi)放外周靜脈,靜脈滴注乳酸鈉林格氏夜,速度設(shè)置為5~8 mL/min,同時(shí)對(duì)患者ECG、SpO2、BO和HPV指標(biāo)進(jìn)行實(shí)時(shí)監(jiān)測(cè)[3]。實(shí)驗(yàn)組患者在接受麻醉誘導(dǎo)前10 min使用0.5 μg/kg負(fù)荷量右美托咪定進(jìn)行靜脈泵注,連續(xù)給予0.2 μg/(kg·h)泵注指導(dǎo)氣管插管5 min后停止。對(duì)照組患者則接受等量生理鹽水泵注[4]。經(jīng)負(fù)荷量輸注后,患者開(kāi)始接受麻醉誘導(dǎo),即給予0.05 mg/kg咪唑安定、1~2 mg/kg丙泊酚、4 μg/kg芬太尼、0.1 mg維庫(kù)溴銨進(jìn)行靜脈注射,4 min后氣管插管接通麻醉機(jī)進(jìn)行機(jī)械通氣[5],記錄患者各個(gè)時(shí)間點(diǎn)的HR、MAP及HRV頻域分析指標(biāo)。時(shí)間點(diǎn)分別為T(mén)0、T1、T2、T3、T4、T5,分別代表為靜息時(shí)、負(fù)荷量結(jié)束、氣管插管前即刻、插管后1 min、插管3 min后、插管5 min后。
1.3 統(tǒng)計(jì)方法
數(shù)據(jù)均采用SPPS 11.5統(tǒng)計(jì)學(xué)軟件分析。計(jì)量資料以(x±s)表示,行t檢驗(yàn),P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2 結(jié)果
分析可知,實(shí)驗(yàn)組患者在負(fù)荷量結(jié)束至插管5 min間HR減緩,MAR降低,與靜息時(shí)相比差異有統(tǒng)計(jì)學(xué)意義(P<0.05);實(shí)驗(yàn)組患在插管后1 minHR減緩,負(fù)荷量結(jié)束時(shí)MAP降低,與對(duì)照組相比差異有統(tǒng)計(jì)學(xué)意義(P<0.05);對(duì)照組患者在插管1 min至插管5 min間各指標(biāo)低頻和高頻值均高于負(fù)荷量結(jié)束,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。
3 討論
心率變異性分析是一種無(wú)創(chuàng)性檢測(cè),對(duì)心臟交感和副交感神經(jīng)活動(dòng)的緊張性、均衡性及對(duì)心血管系統(tǒng)的影響具有檢測(cè)作用[6],多用于心臟自主神經(jīng)功能的監(jiān)測(cè)。作為誘發(fā)人體自主神經(jīng)總張力、交感神經(jīng)及迷走神經(jīng)張力降低的獨(dú)立因素,糖尿病所誘發(fā)的交感和迷走神經(jīng)對(duì)心臟調(diào)節(jié)造成的雙重?fù)p害以LF、HF和LF/HF發(fā)生明顯降低為主要表現(xiàn)[7]。喉頸和氣管插管等機(jī)械性操作將會(huì)引發(fā)交感神經(jīng)興奮,使得糖尿病發(fā)生麻醉意外風(fēng)險(xiǎn)的幾率增加[8]。結(jié)合該次研究結(jié)果可知,在糖尿病患者全麻誘導(dǎo)期間應(yīng)用右美托咪定不會(huì)對(duì)心率變異性造成顯著影響,其影響較小,對(duì)于氣道插管反應(yīng)有一定的抑制作用。
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(收稿日期:2018-01-14)