文章摘要
不同剂量右美托咪定对成年患者心脏电生理平衡的影响
Effects of different doses of dexmedetomidine on cardiac electrophysiological balance in adult patients
  
DOI：10.12089/jca.2019.06.006
中文关键词: 右美托咪定  心脏电生理平衡指数  心电描记术
英文关键词: Dexmedetomidine  Index of cardiac electrophysiological balance  Electrocardiography
基金项目:贵州省卫生计生委科学技术基金项目(gzwjkj2017-1-083)
作者单位E-mail
刘艳秋 550004,贵阳市,贵州医科大学附属医院麻醉科  
邱军 纳雍县人民医院麻醉科  
李惠 550004,贵阳市,贵州医科大学附属医院麻醉科  
李华宇 550004,贵阳市,贵州医科大学附属医院麻醉科  
符校魁 550004,贵阳市,贵州医科大学附属医院麻醉科  
黄岁岁 550004,贵阳市,贵州医科大学附属医院麻醉科  
高鸿 550004,贵阳市,贵州医科大学附属医院麻醉科 2169617@qq.com 
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中文摘要:
      
目的 观察不同剂量右美托咪定对成年患者心脏电生理平衡的影响。
方法 择期全麻手术患者80例，男28例，女52例，年龄18~60岁，BMI 18.5~23.9 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字表法分为四组：对照组（C组）、右美托咪定低浓度组（L组）、中浓度组（M组）和高浓度组（H组），每组20例。L组、M组和H组10 min内输注0.6、0.8、1.0 μg/kg负荷量右美托咪定后，分别泵注0.3、0.4、0.5 μg·kg-1·h-1维持量右美托咪定20 min；C组静脉泵注等容量生理盐水。在右美托咪定泵注前（T0）、右美托咪定负荷量输注10 min（T1）、右美托咪定维持量输注20 min（T2）时采集12导联心电图，测量计算QT间期、QTc间期、Tp-e间期、Tp-e/QT比值及心脏电生理平衡指数（icEB），同时记录HR和MAP。
结果 与T0和C组比较，L组、M组及H组T1时HR明显减慢，T2时MAP明显降低，HR明显减慢（P<0.05）。与T1时比较，T2时L组、M组及H组MAP明显降低（P<0.05）。与T0时比较，T1—T2时L组、M组及H组QT间期明显延长，QTc间期明显缩短，Tp-e/QT比值明显减小，iCEB明显增大（P<0.05）。与C组比较，T2时L组、M组及H组QT间期明显延长，QTc间期明显缩短（P<0.05）。
结论 右美托咪定持续输注可破坏心脏电生理平衡，导致心电稳定性降低，增加恶性心律失常的发生风险，但在所用剂量范围内对其影响无剂量依赖性。
英文摘要:
      
Ojective To observe the effects of different doses of dexmedetomidine on cardiac electrophysiological balance in adult patients.
Methods Eighty patients undergoing elective general anesthesia surgery, 28 males and 52 females, aged 18 - 60 years, BMI 18.5 - 23.9 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were enrolled in this study. Then the patients were randomly divided into control group (group C), low dexmedetomidine concentration group (group L), medium dexmedetomidine concentration group (group M) and high dexmedetomidine concentration group (group H) by using a random number table, and 20 in each group. Group L, group M and group H were loaded with dexmedetomidine at doses of 0.6, 0.8, 1.0 μg/kg in 10 min, and continued to be infused at a maintenance dose of 0.3, 0.4 , 0.5 μg·kg-1·h-1 in 20 min, respectively, while group C was administered with the same amount of normal saline. Twelve-lead ECG were recorded at the time befofe using of dexmedetomidine (T0), 10 min after loading of dexmedetomidine (T1), 20 min after maintenance dose (T2) to measure and calculate the QT interval, QTc interval, Tp-e interval, Tp-e /QT ratio and iCEB, and HR and MAP.
Results Compared with T0 and group C, HR was decreased at T1, both MAP and HR were decreased at T2 in groups L, M and H (P < 0.05). Compared with T1, MAP was decreased in group L, group M and group H at T2 (P < 0.05). Compared with T0, the QT interval was prolonged, the QTc interval was shortened, the ratio of Tp-e/QT was decreased, but the iCEB was increased (P < 0.05) in group L, group M and group H at T1 and T2 (P < 0.05). Compared with group C, the QT interval was prolonged but the QTc interval was shortened in group L, group M and group H at T2 (P < 0.05).
Conclusion Continuous infusion of dexmedetomidine leads to the imbalance of cardiac electrophysiology, thus resulting a decreased cardiac electrophysiological stability and increasing the risk of malignant arrhythmia, but no dose-dependency is observed.
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