性别差异对腰-硬联合麻醉期间右美托咪定镇静作用的影响
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摘要
目的:探讨性别差异对腰-硬联合麻醉期间静脉输注右美托咪定镇静作用的影响。方法:选择腰-硬联合麻醉下行下肢骨折手术患者60例,术前1 d时采用阿姆斯特丹焦虑量表(APAIS)评估患者术前焦虑程度;将60例患者均分为男性组和女性组,两组患者在鞘内注射麻醉药物后10 min静脉输注右美托咪定1μg/kg、并以0.5μg/(kg·h)持续泵注至手术结束前15 min;观察并记录患者入室后5 min(T_0),输注右美托咪定后10 min(T_1)、20 min(T_2)、30 min(T_3)及60 min(T_4)时的心率(HR)、血压(BP)、血氧饱和度(SpO_2)、Narcotrend指数(NI)及相应时间点的警觉/镇静(OAA/S)评分及OAA/S评分达3分所需时间,记录术中低血压和心动过缓等心血管事件的发生情况。结果:患者OAA/S评分达3分时所需时间与APAIS评分符合线性相关(r~2=0.537,P<0.05),且男性组患者所需时间短于女性组患者,差异有统计学意义(P<0.05);两组患者HR在T0～T1下降最明显,且T1时HR低于其他时间点HR (P<0.05),T1时男性组患者NI、OAA/S评分低于女性组,T2时男性组患者NI、OAA/S评分高于女性组,差异有统计学意义(P<0.05);男性组心动过缓的发生率11例(36.7%),高于女性组的4例(13.3%),差异有统计学意义(P<0.05)。结论:腰-硬联合麻醉期间静脉输注右美托咪定镇静作用存在性别差异,且术前焦虑可能是一个重要影响因素。
Objective: To investigate the effect of gender difference on intravenous dexmedetomidine for sedation during combined spinal-epidural anesthesia in young and middle-aged patients. Methods: Sixty patients aged 18-60 years, ASA physical status Ⅰ or Ⅱ,during combined spinal-epidural anesthesia, scheduled for elective lower limb fracture surgery, were divided into 2 groups(n=30 each): male dexmedetomidine group(MD group) and female dexmedetomidine group(FD group). The preoperative anxiety levels were evaluated by Amsterdam preoperative anxiety and information scale(APAIS). The two groups received a loading dose of dexmedetomidine 1 μg/kg IV for 15 min in 10 min after an intrathecal injection, followed by a maintenance dose of 0.5 μg/(kg·h) till 15 min before the end of surgery. Heart rate(HR), noninvasive systolic blood pressure(SBP), oxygen saturation(SpO_2) and Narcotrend index(NI) value, as well as the Observer's Assessment of Alertness/Sedation Scale(OAA/S) scores at the correspondingtime points were all recorded 5 min after entering the operating room(T_0), 10 min(T_1), 20 min(T_2), 30 min(T_3) and 60 min(T_4) after administration of dexmedetomidine. The time required for reaching OAA/S score 4 was recorded. The incidence of intraoperative cardiovascular events was recorded. After operation, patients were sent to postanesthetic care unit(PACU) and were not sent back to the ward until the NI>80 and/or OAA/S score>4. Results: The time required for the OAA/S score of 3 was correlated with APAIS scores(r~2=0.537,P<0.05), the time required in MD group was shorter than that in FD group(P<0.05). The heart rate of the two groups decreased most significantly at T1～T2 and at T1 it was lower than the corresponding heart rate at other time points(P<0.05). The NI and OAA/S scores in MD group at T1 were lower than those in FD group(P<0.05), and the NI and OAA/S scores in MD group at T2 were higher than those in FD group(P<0.05). The incidence of bradycardia in MD group was in 11 cases(36.7%), which was higher than that in 4 cases of FD group(13.3%)(P<0.05). Conclusion: Gender difference exists in the sedative effect on the function of dexmedetomidine intravenous infusion during combined spinal-epidural anesthesia, and preoperative anxiety may be an important factor.
Objective: To investigate the effect of gender difference on intravenous dexmedetomidine for sedation during combined spinal-epidural anesthesia in young and middle-aged patients. Methods: Sixty patients aged 18-60 years, ASA physical status Ⅰ or Ⅱ,during combined spinal-epidural anesthesia, scheduled for elective lower limb fracture surgery, were divided into 2 groups(n=30 each): male dexmedetomidine group(MD group) and female dexmedetomidine group(FD group). The preoperative anxiety levels were evaluated by Amsterdam preoperative anxiety and information scale(APAIS). The two groups received a loading dose of dexmedetomidine 1 μg/kg IV for 15 min in 10 min after an intrathecal injection, followed by a maintenance dose of 0.5 μg/(kg·h) till 15 min before the end of surgery. Heart rate(HR), noninvasive systolic blood pressure(SBP), oxygen saturation(SpO_2) and Narcotrend index(NI) value, as well as the Observer's Assessment of Alertness/Sedation Scale(OAA/S) scores at the correspondingtime points were all recorded 5 min after entering the operating room(T_0), 10 min(T_1), 20 min(T_2), 30 min(T_3) and 60 min(T_4) after administration of dexmedetomidine. The time required for reaching OAA/S score 4 was recorded. The incidence of intraoperative cardiovascular events was recorded. After operation, patients were sent to postanesthetic care unit(PACU) and were not sent back to the ward until the NI>80 and/or OAA/S score>4. Results: The time required for the OAA/S score of 3 was correlated with APAIS scores(r~2=0.537,P<0.05), the time required in MD group was shorter than that in FD group(P<0.05). The heart rate of the two groups decreased most significantly at T1～T2 and at T1 it was lower than the corresponding heart rate at other time points(P<0.05). The NI and OAA/S scores in MD group at T1 were lower than those in FD group(P<0.05), and the NI and OAA/S scores in MD group at T2 were higher than those in FD group(P<0.05). The incidence of bradycardia in MD group was in 11 cases(36.7%), which was higher than that in 4 cases of FD group(13.3%)(P<0.05). Conclusion: Gender difference exists in the sedative effect on the function of dexmedetomidine intravenous infusion during combined spinal-epidural anesthesia, and preoperative anxiety may be an important factor.
引文
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[12]林振华,程明华,庄少惠,等.术前焦虑患者术中应用右美托咪定的镇静效果[J].中国医药,2016,11(4):564-568.
[13]DOUK-KEUN Y,BAN J S,SANG-GON L,et al.Dexmedetomidine combined with midazolam vs.dexmedetomidine alone for sedation during spinal anesthesia[J].Korean Journal of Anesthesiology,2016,69(5):446-452.
[14]GERTLER R,BROWN H C,MITCHELL D H,et al.Dexmedetomidine:a novel sedative-analgesic agent[J].Proceedings,2001,14(1):13.
[15]TRILTSCH A E,WELTE M,VON HOMEYER P,et al.Bispectral index-guided sedation with dexmedetomidine in intensive care:a prospective,randomized,double blind,placebo-controlled phase II study[J].Critical care medicine,2002,30(5):1007-1014.
[16]YEKTAS A,GUMUS F,ALAGOL A.Dexmedetomidine and propofol infusion on sedation characteristics in patients undergoing sciatic nerve block in combination with femoral nerve block via anterior approach[J].Revista brasileira de anestesiologia,2015,65(5):371-378.
[17]SHAH P J,DUBEY K P,SAHARE K K,et al.Intravenous dexmedetomidine versus propofol for intraoperative moderate sedation during spinal anesthesia:A comparative study[J].Journal of anaesthesiology,clinical pharmacology,2016,32(2):245-249.
[18]XU B,LI Z,ZHOU D,et al.The influence of age on sensitivity to dexmedetomidine sedation during spinal anesthesia in lower limb orthopedic surgery[J].Anesth Analg,2017,125(6):1907-1910.
[19]ELEVELD D J,PROOST J H,CORTíNEZ L I,et al.A general purpose pharmacokinetic model for propofol[J].Anesthesia & Analgesia,2014,118(6):1221.
[20]DYCK J B,MAZE M,HAACK C,et al.Computer-controlled infusion of intravenous dexmedetomidine hydrochloride in adult human volunteers[J].Anesthesiology,1993,78(5):821-828.
[21]PARK S H,SHIN Y D,YU H J,et al.Comparison of two dosing schedules of intravenous dexmedetomidine in elderly patients during spinal anesthesia[J].Korean J Anesthesiol,2014,66(5):371-376.
[22]WANG T,GE S,XIONG W,et al.Effects of different loading doses of dexmedetomidine on bispectral index under stepwise propofol target-controlled infusion[J].Pharmacology,2013,91(1-2):1-6.
[23]LEE M H,KO J H,KIM EEM,et al.The effects of intravenous dexmedetomidine on spinal anesthesia:comparision of different dose of dexmedetomidine[J].Korean J Anesthesiol,2014,67(4):252-257.
[24]SIM J H,YU H J,KIM S T.The effects of different loading doses of dexmedetomidine on sedation[J].Korean J Anesthesiol,2014,67(1):8-12.
[2] JO Y Y,LEE D,JUNG W S,et al.Comparison of Intravenous Dexmedetomidine and Midazolam for Bispectral Index-Guided Sedation During Spinal Anesthesia[J].Medical Science Monitor,2016,22:3544-3551.
[3] SHAH P J,DUBEY K P,SAHARE K K,et al.Intravenous dexmedetomidine versus propofol for intraoperative moderate sedation during spinal anesthesia:A comparative study[J].Journal of Anaesthesiology Clinical Pharmacology,2016,32(2):245.
[4] SIDDA R V,AHMED S N,BALAJI D,et al.Intravenous dexmedetomidine versus clonidine for prolongation of bupivacaine spinal anesthesia and analgesia:A randomized double-blind study[J].Journal of Anaesthesiology Clinical Pharmacology,2013,29(3):342-347.
[5] SCIBELLI G,MAIO L,SASSO M,et al.Dexmedetomidine:Current Role in Burn ICU[J].Translational medicine,2017,16:1-10.
[6] KIM J,KIM W O,KIM H B,et al.Adequate sedation with single-dose dexmedetomidine in patients undergoing transurethral resection of the prostate with spinal anaesthesia:a dose-response study by age group[J].BMC anesthesiology,2015,27:15:17.
[7] NIU X Y,DING X B,GUO T,et al.Effects of intravenous and intrathecal dexmedetomidine in spinal anesthesia:a meta-analysis[J].CNS neuroscience & therapeutics,2013,19(11):897-904.
[8] ZHANG Z,FERRETTI V,GUNTAN I,et al.Neuronal ensembles sufficient for recovery sleep and the sedative actions of alpha2 adrenergic agonists[J].Nat Neurosci,2015,18(4):553-561.
[9] BANGASSER D A,WIERSIELIS K R,KHANTSIS S.Sex differences in the locus coeruleus-norepinephrine system and its regulation by stress[J].Brain research,2016,1641(B):177-188.
[10]SELMANOFF M K,PRAMIKHOLDAWAY M J,WEINER R I.Concentrations of dopamine and norepinephrine in discrete hypothalamic nuclei during the rat estrous cycle[J].Endocrinology,1976,99(1):326.
[11]MAVRIDOU P,DIMITRIOU V,MANATAKI A,et al.Patient's anxiety and fear of anesthesia:effect of gender,age,education,and previous experience of anesthesia.A survey of 400 patients[J].Journal of Anesthesia,2013,27(1):104-108.
[12]林振华,程明华,庄少惠,等.术前焦虑患者术中应用右美托咪定的镇静效果[J].中国医药,2016,11(4):564-568.
[13]DOUK-KEUN Y,BAN J S,SANG-GON L,et al.Dexmedetomidine combined with midazolam vs.dexmedetomidine alone for sedation during spinal anesthesia[J].Korean Journal of Anesthesiology,2016,69(5):446-452.
[14]GERTLER R,BROWN H C,MITCHELL D H,et al.Dexmedetomidine:a novel sedative-analgesic agent[J].Proceedings,2001,14(1):13.
[15]TRILTSCH A E,WELTE M,VON HOMEYER P,et al.Bispectral index-guided sedation with dexmedetomidine in intensive care:a prospective,randomized,double blind,placebo-controlled phase II study[J].Critical care medicine,2002,30(5):1007-1014.
[16]YEKTAS A,GUMUS F,ALAGOL A.Dexmedetomidine and propofol infusion on sedation characteristics in patients undergoing sciatic nerve block in combination with femoral nerve block via anterior approach[J].Revista brasileira de anestesiologia,2015,65(5):371-378.
[17]SHAH P J,DUBEY K P,SAHARE K K,et al.Intravenous dexmedetomidine versus propofol for intraoperative moderate sedation during spinal anesthesia:A comparative study[J].Journal of anaesthesiology,clinical pharmacology,2016,32(2):245-249.
[18]XU B,LI Z,ZHOU D,et al.The influence of age on sensitivity to dexmedetomidine sedation during spinal anesthesia in lower limb orthopedic surgery[J].Anesth Analg,2017,125(6):1907-1910.
[19]ELEVELD D J,PROOST J H,CORTíNEZ L I,et al.A general purpose pharmacokinetic model for propofol[J].Anesthesia & Analgesia,2014,118(6):1221.
[20]DYCK J B,MAZE M,HAACK C,et al.Computer-controlled infusion of intravenous dexmedetomidine hydrochloride in adult human volunteers[J].Anesthesiology,1993,78(5):821-828.
[21]PARK S H,SHIN Y D,YU H J,et al.Comparison of two dosing schedules of intravenous dexmedetomidine in elderly patients during spinal anesthesia[J].Korean J Anesthesiol,2014,66(5):371-376.
[22]WANG T,GE S,XIONG W,et al.Effects of different loading doses of dexmedetomidine on bispectral index under stepwise propofol target-controlled infusion[J].Pharmacology,2013,91(1-2):1-6.
[23]LEE M H,KO J H,KIM EEM,et al.The effects of intravenous dexmedetomidine on spinal anesthesia:comparision of different dose of dexmedetomidine[J].Korean J Anesthesiol,2014,67(4):252-257.
[24]SIM J H,YU H J,KIM S T.The effects of different loading doses of dexmedetomidine on sedation[J].Korean J Anesthesiol,2014,67(1):8-12.