【罂粟摘要】右美托咪定在臂丛阻滞下矫形外科上肢手术患者中引起的血流动力学不稳定性：一项回顾性研究
右美托咪定在臂丛阻滞下矫形外科上肢手术患者中引起的血流动力学不稳定性：一项回顾性研究
翻译：安丽 编辑：佟睿 审核：曹莹
贵州医科大学 麻醉与心脏电生理课题组
血流动力学不稳定是右美托咪定（DMED）给药后常见的不良反应。在本研究中，我们评估了右美托咪定在临床区域麻醉实施中引起的血流动力学不稳定的发生率及其的预测因素。
回顾性分析了在臂丛神经阻滞下进行上肢矫形手术并静脉泵注右美托咪定的患者116例。主要观察指标是右美托咪定引起的血流动力学不稳定的发生率。受试者根据血流动力学稳定状态分为稳定组和不稳定组，比较两组患者的特征。采用logistic回归模型分析右美托咪定引起的血流动力学不稳定性与潜在危险因素之间的关系。
观察到右美托咪定引起的血流动力学不稳定在116例患者中占14.7%（17/116）。不稳定组的女性多于稳定组（分别为76.5%和39.4%，P = 0.010). 根据体重指数将患者分为四个亚组（体重过轻、正常体重、超重和肥胖），两组的亚组组成有显著差异(P=0.008)。在单因素分析中，女性、肥胖和既往患高血压是右美托咪定引起血流动力学不稳定的重要预测因素。多因素分析显示女性(校正OR 3.86, CI 1.09;13.59, P=0.036)和肥胖(校正OR 6.41, CI 1.22;33.57, P=0.028)是右美托咪定引起的血流动力学不稳定的独立预测因素。
在临床区域麻醉实施中，女性和肥胖患者在静脉泵注右美托咪定后更容易出现血流动力学不稳定。本研究提示：减少右美托咪定的使用剂量可预防此类人群的低血压风险。
A Ram Doo, Hyungseok Lee, Seon Ju Baek and Jeongwoo Lee.Dexmedetomidine-induced hemodynamic instability in patients undergoing orthopedic upper limb surgery under brachial plexus block: a retrospective study.BMC Anesthesiol. (2021) 21:207.
Dexmedetomidine-induced hemodynamic instability in patients undergoing orthopedic upper limb surgery under brachial plexus block: a retrospective study.
Abstract
Background：Hemodynamic instability is a frequent adverse effect following administration of dexmedetomidine (DMED). In this study, we evaluated the incidence of DMED-induced hemodynamic instability and its predictive factors in clinical regional anesthesia practice.
Method: One hundred sixteen patients who underwent orthopedic upper limb surgery under brachial plexus block with intravenous DMED administration were retrospectively identified. The primary outcome was the incidence of DMED-induced hemodynamic instability. The participants were allocated to a stable or unstable group by their hemodynamic instability status. Patients' characteristics were compared between the groups. The relationship between the potential risk factors and development of DMED-induced hemodynamic instability was analyzed with a logistic regression model.
Result: DMED-induced hemodynamic instability was observed in 14.7% of patients (17/116). The unstable group had more women than the stable group (76.5% vs. 39.4%, P = 0.010). When patients were classified into four subgroup according to body mass index (underweight, normal weight, overweight, and obesity), there was significant difference in the composition of the subgroups in the two groups (P = 0.008). In univariate analysis, female sex, obesity, and pre-existing hypertension were significant predictors of DMED-induced hemodynamic instability. Multivariate analysis demonstrated that female sex (adjusted OR 3.86, CI 1.09; 13.59, P = 0.036) and obesity (adjusted OR 6.41, CI 1.22; 33.57, P = 0.028) were independent predictors of DMED-induced hemodynamic instability.
Conclusion: Female and obese patients are more likely to have hemodynamic instability following intravenous DMED administration in clinical regional anesthesia practice. This study suggests that DMED dose may be diminished to prevent hypotensive risk in these populations.
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