一定负荷剂量的右美托咪定复合异丙酚或七氟醚时对麻醉维持期间血流动力学变化的比较：一项前瞻性随机双盲对照临床试验
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Comparison of a loading dose of dexmedetomidine combined with propofol or sevoflurane for hemodynamic changes during anesthesia maintenance: a prospective, randomized, double-blind, controlled clinical trial
背景与目的
右美托咪定对血流动力学的影响可能存在很大的个体差异。因此，必须仔细调整剂量以达到预期的临床效果。在麻醉维持期间，一定负荷剂量的右美托咪定是否会产生血流动力学的副作用是未知的。本研究的目的是比较一定负荷剂量的右美托咪定复合异丙酚或七氟醚时对麻醉维持期间血流动力学变化的影响。
方 法
84例行平衡全麻手术的患者被随机分为4组（n=21例）：异丙酚+右美托咪定组，七氟醚+右美托咪定组，异丙酚+生理盐水组，七氟醚+生理盐水组。记录该研究药物（右美托咪定或生理盐水）输注之前，之后5分钟和结束时的血流动力学指标。评估研究药物输注结束时血压升高（大于基线或研究药物输注前的20％）的发生率。
结 果
异丙酚复合右美托咪定组在静脉注射右美托咪定后较前相比平均动脉压显著升高（P <0.01）。异丙酚复合右美托咪定组80％的患者平均动脉压升高，而七氟醚复合右美托咪定组仅有5％（P <0.05）。异丙酚复合右美托咪定组以及七氟醚复合右美托咪定组的心率在右美托咪定输注后均显著降低（P <0.01）。
结 论
术中给予一定负荷剂量的右美托咪定复合异丙酚时使麻醉维持期间的血压显著升高。反之，它与七氟醚联合使用则不会使血压升高。同时由于已知的右美托咪定的副作用，右美托咪定复合异丙酚或七氟醚时使心率降低在意料之中。因此，在整个静脉麻醉维持期间，特别是使用异丙酚时，应谨慎使用右美托咪定。
原始文献摘要
Han Y, Han L, Dong M, Sun Q, Ding K, Zhang Z, Cao J, Zhang Y；Comparison of a loading dose of dexmedetomidine combined with propofol or sevoflurane for hemodynamic changes during anesthesia maintenance: a prospective, randomized, double-blind, controlled clinical trial；BMC Anesthesiol. 2018 Jan 24;18(1):12. doi: 10.1186/s12871-018-0468-x.
Background: There may be great individual variability in the hemodynamic effects of this dexmedetomidine. For this reason, the dose must be carefully adjusted to achieve the desired clinical effect. Whether a loading dose of dexmedetomidine produces hemodynamic side effects during the anesthesia maintenance is unknown. The aim of this study was to compare the effects of a loading dose of dexmedetomidine combined with propofol or sevoflurane on hemodynamics during anesthesia maintenance.
Methods: Eighty-four patients who were scheduled for general surgery under balanced general anesthesia were randomly allocated into 4 groups (n = 21): the propofol and dexmedetomidine group, the sevoflurane and dexmedetomidine group, the propofol and normal saline group, or the sevoflurane and normal saline group. The hemodynamic indexes at the time of just before, 5 min after and the end of study drug infusion (dexmedetomidine or normal saline) were recorded. The incidence rates of increasing blood pressure at the end of study drug infusion (greater than 20% compared to baseline or before study drug infusion) were evaluated.
Results: Mean arterial pressure increased significantly (P < 0.01) only in the propofol and dexmedetomidine group after intravenous dexmedetomidine compared administration. 80% of cases with propofol and dexmedetomidine had increased mean arterial blood pressure compared to only 5% of cases in the sevoflurane and dexmedetomidine group (P < 0.05). Heart rates in the propofol and dexmedetomidine and the sevoflurane and dexmedetomidine groups decreased significantly after dexmedetomidine infusion (P < 0.01).
Conclusions: Intraoperative administration of a loading dose of dexmedetomidine combined with propofol in anesthesia maintenance proceeded a significant increase in blood pressure. In contrast, it combines with sevoflurane didn’t produce increased blood pressure. Meanwhile it is not unexpected that dexmedetomidine combined with propofol or sevofurance decreased heart rate, due to the known side effects of DEX. Therefore, dexmedetomidine should be used cautiously during the entire intravenous anesthesia maintenance period, especially during maintenance with propofol.
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