不同剂量右美托咪定对全麻患者围术期心肌细胞电生理的影响

Effects of different doses of dexmedetomidine on the electrophysiology of cardiomyocytes in patients under general anesthesia during perioperative period

中文关键词: 右美托咪定  围术期  电生理  心功能

英文关键词: Dexmedetomidine  Perioperative period  Electrophysiology  Cardiac function

中文摘要:

      
目的 探讨不同剂量右美托咪定对全麻患者围术期心肌细胞电生理及心功能的影响。
方法 选择2020年9月至2021年3月行择期全麻手术患者69例，男33例，女36例，年龄18～64岁，BMI 18～30 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为四组：右美托咪定负荷剂量1 μg/kg及维持剂量1 μg·kg^-1·h^-1（D₁组）、右美托咪定负荷剂量1 μg/kg及维持剂量0.5 μg·kg^-1·h^-1（D₂组）、右美托咪定负荷剂量0.5 μg/kg及维持剂量0.5 μg·kg^-1·h^-1（D₃组）和生理盐水负荷剂量50 ml/h输注10 min及维持剂量10 ml/h（C组）。于右美托咪定/生理盐水使用前（T₁）、负荷剂量完成时（T₂）、手术结束即刻（T₆）、入PACU后1 h（T₇）、术后24 h（T₈）、术后48 h（T₉）、术后72 h（T₁₀）及术后1个月（T₁₁）时采集12导联心电图，记录QTc间期，计算心脏电生理平衡指数（iCEB）。于T₁、T₂、手术开始时（T₃）、手术开始30 min（T₄）、手术开始1 h（T₅）、T₆、T₇时记录心脏循环效率（CCE）等心功能指标。
结果 与C组比较，T₂时D₁组和D₂组QTc间期明显延长（P<0.05），T₇、T₈时D₃组QTc间期明显缩短(P<0.05)，T₈时D₃组iCEB明显减小（P<0.05），T₂时D₁组和D₂组、T₃时D₁组CCE明显减小（P<0.05）。与D₁组比较，D₃组T₂、T₆、T₇、T₉、T₁₀时QTc间期明显缩短（P<0.05），T₈时iCEB明显减小（P<0.05），T₂—T₄时CCE明显增大（P<0.05）。与D₂组比较，D₃组T₂时QTc间期明显缩短（P<0.05）、T₈时iCEB明显减小（P<0.05），T₂—T₃时CCE明显增大（P<0.05）。
结论 全身麻醉手术中静脉输注右美托咪定负荷剂量0.5 μg/kg及维持剂量0.5 μg·kg^-1·h^-1可维持患者围术期心肌电生理的稳定，降低心律失常的发生率，且不影响心脏输出效率。

英文摘要:

      
Objective To investigate the effects of different doses of dexmedetomidine on perioperative electrophysiology of cardiomyocytes and cardiac function in patients under general anesthesia.
Methods Sixty-nine patients under general anesthesia from September 2020 to March 2021, 33 males and 36 females, aged 18-64 years, BMI 18-30 kg/m², ASA physical status Ⅰ or Ⅱ, were randomly divided into four groups: dexmedetomidine load dose 1 μg/kg and maintenance dose 1 μg·kg^-1·h^-1 (group D₁), dexmedetomidine load dose 1 μg/kg and maintenance dose 0.5 μg·kg^-1·h^-1 (group D₂), dexmedetomidine load dose 0.5 μg/kg and maintenance dose 0.5 μg·kg^-1·h^-1 (group D₃), normal saline 50 ml/h for 10 minutes and maintenance with 10 ml/h (group C). Twelve-lead electrocardiograms were recorded at the time before dexmedetomidine/normal saline infusion (T₁), loading dose finished (T₂), ending of surgery (T₆), 1 hour after entering PACU (T₇), 24 hours (T₈), 48 hours (T₉), 72 hours (T₁₀) and 1 month (T₁₁) postoperatively. Corrected QT interval (QTc), index of cardiac electrophysiological balance (iCEB) were recorded. Cardiac circulation efficiency (CCE) were recorded at T₁, T₂, beginning of surgery (T₃), 30 minutes (T₄), 1 hour (T₅) after the beginning of surgery, T₆ and T₇.
Results Compared with group C, QTc in groups D₁ and D₂ increased significantly at T₂ and in group D₃ were decreased significantly at T₇ and T₈ (P < 0.05), and iCEB in group D₃ was decreased significanthy at T₈(P < 0.05), and CCE in group D₁ at T₂ and T₃ and in group D₂ at T₂ were significantly lower (P < 0.05). Compared with group D₁, QTc at T₂, T₆, T₇, T₉ and T₁₀ and iCEB at T₈ in group D₃ were decreased significantly (P < 0.05), and CCE at T₂-T₄ in group D₃ were increased significantly (P < 0.05). Compared with group D₂, QTc at T₂ and iCEB at T₈ in group D₃ were decreased significantly (P < 0.05), and CCE at T₂ and T₃ in group D₃ were increased significantly (P < 0.05).
Conclusion Dexmedetomidine loading dose 0.5 μg/kg and maintenance dose 0.5 μg·kg^-1·h^-1 under general anesthesia can maintain the stability of perioperative cardiac electrophysiology, and reduce the incidence of arrhrythmia, and it does not affect cardiac output efficiency.