【罂粟摘要】应用右美托咪定对2型糖尿病患者行蛛网膜下腔阻滞麻醉时患者心率变异性的动态研究
应用右美托咪定对2型糖尿病患者行蛛网膜下腔阻滞麻醉时患者心率变异性的动态研究
贵州医科大学 高鸿教授课题组
翻译：安丽 编辑：佟睿 审校：曹莹
探讨2型糖尿病(T2DM)患者应用右美托咪定实施蛛网膜下腔阻滞麻醉行下肢手术后的心率变异性(HRV)的动态变化。
根据糖化血红蛋白(HbA1c)水平将T2DM患者分为受控组(HbA1c < 7%)和未受控制组(HbA1c > 7%)，非T2DM患者为正常组，每组30例。测量应用右美托咪定实施蛛网膜下腔阻滞麻醉前10 min、实施麻醉后10 min (T1)、20 min (T2)、30 min (T3)时HRV(包括低频功率、高频功率、总功率、LF/HF比值)。
T0时，未控制组TP、LF、HF功率明显低于其他两组(P < 0.05)。受控组在T1-2时LF功率明显低于正常组。未受控制组的LF功率在各时间点均无明显变化，但在T1-3时明显低于对照组。三组高频功率在不同时间点均无明显变化，但未受控制组高频功率明显低于正常组和控制组。三组患者在T1-3时LF/HF比值均显著下降，组间无显著差异。三组患者的心率在腰麻后均有下降趋势，组间无明显差异。三组T1-3收缩压、舒张压均明显低于T0时，T1-3收缩压(SBP)、舒张压(DBP)未受控制组明显高于正常组和控制组。
右美托咪定腰麻对T2DM患者下肢手术中血糖控制较好的患者自主神经功能有影响，对血糖控制不佳的患者无显著影响。对于这类患者，腰麻可导致收缩压和舒张压明显增加。
原始文献来源：
Liying Ye , Bo Dai , Zheyou Wu, et al.Dynamics of heart rate variability in patients with type 2 diabetes mellitus during spinal anesthesia using dexmedetomidine.[J]Am J Transl Res 2021;13(5):5395-5403.
Dynamics of heart rate variability in patients with type 2 diabetes mellitus during spinal anesthesia using dexmedetomidine
Objective The aim of this study was to investigate the heart rate variability (HRV) in patients with Type 2 di-abetes mellitus (T2DM) who underwent spinal anesthesia using dexmedetomidine for lower limb surgery.
Methods T2DM patients were divided into two groups, namely the controlled group (HbA1c < 7%) and the uncontrolled group (HbA1c > 7%) according to the glycosylated hemoglobin (HbA1c) level, and patients with non-T2DM as the normal group, 30 cases in each group. The HRV, including low-frequency (LF) power, high-frequency (HF) power, total power (TP) and LF/HF ratio, was measured 10 min before spinal anesthesia (T0) and 10 min (T1), 20 min (T2) and 30 min (T3) after spinal anesthesia with dexmedetomidine.
Results We observed that TP, LF, and HF power in the uncontrolled group were remarkably lower than that in the other two groups at T0 (P < 0.05). In the controlled group, the LF power dropped markedly at T1-2 than the normal group. The LF power in the uncontrolled group did not show significant change at all time points, but was significantly lower than the level in the controlled group at T1-3. The HF power in the three groups did not alter markedly at different time points, but the HF power in the uncontrolled group was markedly lower than that in the normal group and the controlled group. In all three groups, the LF/HF ratio dropped markedly at T1-3 with no markedly difference between the groups. The heart rhythms in the three groups showed a decrease trend after spinal anesthesia with no markedly difference between the groups. The SBP and DBP at T1-3 in the three groups were markedly lower than that at T0, and the systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T1-3 in the uncontrolled group were markedly higher than those in the normal group and the controlled group.
Conclusion Spinal anesthesia with dexmedetomidine affects autonomic nerve function in patients whose glycemic control is better during the lower limb surgery in T2DM patients, but has no significant effect on patients who fail to do so. For such patients, spinal anesthesia can result in a markedly increase in SBP and DBP.