Flotrac/Vigileo系统测量腰硬联合麻醉下右美托咪啶负荷剂量对血流动力参数的影响

【摘要】 目的 观察使用Flotrac/Vigileo系统监测下,右美托咪啶负荷剂量对血流动力学参数的影响。方法 60例择期在腰硬联合麻醉下行泌尿腹腔镜手术的患者,随机分为右美托咪啶组(Dex组)和对照组(Con组)。腰麻平面固定后,Dex组泵注0.5 ?滋g/kg右美托咪啶,Con组泵注等量生理盐水,泵注时间为10 min。通过Flotrac/Vigileo系统监测并记录麻醉前、麻醉平面稳定后、开始泵注药物后1 min、3 min、5 min、7 min、10 min、30 min的MAP、HR、CO、CI、CVP,根据以上参数在Vigileo监护仪上计算相应时点的外周血管阻力(SVR),并从桡动脉抽血行血气检测以了解相应时点的血乳酸值。结果 与Con组相比,Dex组患者用药1 min后SVR降低、CVP升高(P<0.05);5 min后CO及CI均下降(P<0.05);7 min后MAP下降(P<0.05);10 min后HR下降(P<0.05);Lac无明显差异。结论 右美托咪啶负荷剂量可引起血压下降伴心率、心输出量及外周血管阻力降低,CVP升高。Flotrac/Vigileo监测系统能更早反映血流动力学参数的变化。

Impact of loading dose of dexmedetomidine on hemodynamic parameters monitored by Flotrac/Vigileo system in combined spinal-epidural anesthesia patients

Objective To observe the hemodynamic impact of loading dose of dexmedetomidine by Flotrac/Vigileo system monitoring. Methods Sixty patients scheduled for elective endourethral surgery under combined spinal-epidural anesthesia were randomized into two groups （group Dex and group Con）. Group dex was infused dexmedetomidine as a loading dose of 0.5μg/kg for 10min after spinal anesthesia blockage level stablized, while group Con received normal saline placebo infusion. The hemodynamic parameters were monitored by Flotrac/Vigileo system. Heart rate （HR）, mean arterial pressure （MAP）, cardiac output （CO）, cardiac index （CI） and central venous pressure （CVP） were monitored. Systemic vascular resistance （SVR） was calculated in vigileo monitor and blood lactate was measure by blood gas analysis. Above parameters were recorded before anesthesia, after the level of anesthesia stable, and 1 min, 3 min, 5 min, 7 min, 10 min, 30 min after dexmedetomidine infusion. Results Compared with group Con, SVR decreased and CVP increased significantly 1 min after infusion in group Dex （P〈O.05）. CO and CI decreased 5rain after infusion （P〈0.05）. MAP decreased 7 min after infusion （P〈0.05）. HR decreased 10 min after infusion （P〈0.05）. Conclusion Loading dose of dexmedetomidine slightly depressed MAP, HR, CO and SVR, and increased CVP as well. Flotrac/Vigileo hemodynamic monitoring could reveal the hemodynamic changes earlier.