心脏手术患者受自身疾病影响，心脏功能存在一定的损害。这类患者麻醉诱导面临更多挑战，极易出现血液动力学大幅度波动，从而发生相关并发症，严重者危及生命。为了维持麻醉诱导期血液动力学的稳定，在临床上使用了很多药物来抑制喉镜暴露和气管插管对血液动力学的不良影响，比如用依托咪酯、咪达唑仑、较大剂量的阿片类镇痛药、利多卡因及血管活性药艾司洛尔和去氧肾上腺素等。右美托咪定作为一种高选择性α2-肾上腺素受体激动剂，具有镇静、镇痛、抗焦虑、抑制交感神经活性、稳定血流动力学，减少麻醉药用量，呼吸抑制轻的特点。那么将右美托咪定用于心脏手术患者麻醉诱导插管效果如何呢，其最佳剂量是多少呢？我们一起学习这篇今年发表在J Anaesthesiol Clin Pharmacol.杂志上的研究Comparisonof the efficacy of two doses of dexmedetomidine in attenuating the hemodynamic responseto intubation in patients undergoing elective cardiac surgery: A randomized double-blindedstudy. (2020 Jan-Mar;36(1):83-87. doi: 10.4103/joacp.JOACP_235_18. Epub 2020Feb 18.)
两种剂量右美托咪定减轻选择性心脏手术患者气管插管所致血流动力学影响的效果比较：一项随机双盲研究。与喉镜检查和插管相关的短暂性心动过速和高血压可能对心脏手术患者造成危险。α2激动剂右美托咪定可能会减弱这种应激反应，但在不引起低血压和心动过缓的情况下达到这一目的的最佳剂量尚未确定。本研究的主要目的是比较15分钟静脉输注两种剂量的右美托咪定（0.5和1μg/kg）对选择性心脏手术中喉镜和气管插管的血流动力学应激反应的影响。76例择期心脏手术患者在诱导前接受单次15分钟静脉输注0.5μg/kg（低剂量）或1μg/kg（高剂量）的右美托咪定。在不同时间记录喉镜和气管插管的血流动力学反应（心率、收缩压、平均动脉压和舒张压）。采用独立样本t检验、关联卡方检验和重复测量方差分析对收集的数据进行分析。低剂量组插管后高血压发生率明显高于对照组。给予1μg/kg的右美托咪定不会导致低血压或心动过缓。1μg/kg剂量的右美托咪定比0.5μg/kg剂量的右美托咪定更有效地减轻心脏手术插管时的血流动力学应激反应。右美托咪定剂量的逐渐增加可能导致最佳剂量的血流动力学反应减弱插管。心脏手术；右美托咪定；气管插管；喉镜检查；应激反应；α2激动剂Comparison of the efficacy of two doses of dexmedetomidinein attenuating the hemodynamic response to intubation in patients undergoing electivecardiac surgery: A randomized double-blinded study.
Transient tachycardia and hypertension associated withlaryngoscopy and intubation may be hazardous to patients presenting for cardiacsurgery. The α 2 agonist dexmedetomidine may blunt this stress response, butthe optimal dose which will accomplish this without causing hypotension andbradycardia is not well established. The primary objective of this study was tocompare the efficacy of two doses of dexmedetomidine (0.5 and 1 μg/kg) as a 15min infusion in attenuating the hemodynamic stress response to laryngoscopy andendotracheal intubation in elective cardiac surgery.Seventy six patients scheduled for elective cardiacsurgery received a single preoperative dose of dexmedetomidine of either 0.5μg/kg (low dose) or 1 μg/kg (high dose) as a 15-min infusion prior toinduction. The hemodynamic response to laryngoscopy and endotracheal intubation(heart rate, systolic blood pressure, mean arterial pressure, and diastolicblood pressure) were recorded at different times. Independent sample t-test,Chi-square test of association, and repeated measures analysis of variance wereused to analyze the collected data.The incidence of hypertension following intubation wassignificantly more in the low-dose group. Administration of 1 μg/kgdexmedetomidine was not accompanied by hypotension or bradycardia.Dexmedetomidine in a dose of 1 μg/kg is more effectivethan 0.5 μg/kg for attenuation of hemodynamic stress response to intubation incardiac surgery. A more graded increase in the dose of dexmedetomidine may leadto an optimum dose in attenuating the hemodynamic response to intubation.cardiac surgery; dexmedetomidine; endotrachealintubation; laryngoscopy; stress response; α 2 agonist 本微信公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供参考。
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