右美托咪定对心内直视手术患者脑电双频谱指数及血流动力学的影响

目的 探讨术前应用右美托咪定对心内直视手术患者脑电双频谱指数及血流动力学的影响.方法 选取拟行心内直视手术患者40例（瓣膜替换术、冠状动脉搭桥术、房颤矫治术、心脏良性肿瘤摘除术）,ASAⅢ-Ⅳ级,年龄45 - 65岁,BMI 20 - 30 kg/m2,随机分为2组,每组20例.D组术前静注右美托咪定1.0 - 1.2 μg/kg;M组术前用吗啡0.1 -0.15 mg/kg,双盲对照观察.记录两组给药后（T1）、麻醉诱导插管后（T2）、插管后3 min（T3）、插管后10 min（T4）、开皮时（T5）、劈胸骨时（T6）各时点的心率（HR）、平均动脉压（MAP）和脑电双频谱指数（BIS）.结果 两组患者给药后各时点HR无明显变化（P＞0.05）;D组MAP于T4和T6时与M组比较差异有统计学意义（P＜0.05）;D组患者BIS值于各时点均明显低于M组,差异有统计学意义（P＜0.05）.结论 右美托咪定在心脏外科手术中对HR和MAP的影响很小,血流动力学稳定,BIS值较低,可产生明显镇静效应.

Effect of dexmedetomidine on bispectral index and hemodynamic in cardiac surgery

Objective To evaluate the effect of dexmedetomidine（DEX） on the bispectral index （BIS）and hemodynamic in the cardiac surgery. Methods Forty ASA class Ⅲ-Ⅳ patients, aged 45 - 65 years, with body mass in dex 20 - 30 kg/m2 , were randomly divided into 2 groups ： morphine group （ group M, n = 20 ） and dexmedetomidine group（group D,n =20）. In group D,a loading dose of dexmedetomidine 1.0 - 1.2 μg/kg was injected at 10 min before induction of anesthesia. In group M,a dose of morphine 0. 1 -0. 15 mg/kg was injected. MAP,HR and BIS were recorded after injection（ T1 ） , immediately after intubation （ T2 ） , 3 min after intubation （ T3 ） , 10 min after intubation （T4） ,immediately skin incision（T5） ,immediately sawing breastbone（T6）. Results There was no significant difference in HR between the two groups after intuabtion（ P 〉 0. 05 ）. Compared with group M, MAP of group D at T4 and T6 were significantly lower（ P 〈 0.05 ）. BIS of group D was lower than group M at all the time points ,there were sig- nificant differences between the two groups （ P 〈 0.05 ）. Conclusion Dexmedetomidine has little impact on HR and MAP with lower BIS,it can produce significant sedative effect in cardiac surgery.