改善颅脑损伤术后盐酸右美托咪定镇静致心率缓慢的临床安全性研究

Clinical Safety Study on Improving the Slow Heart Rate Induced by Dexmedetomidine Hydrochloride Sedation After Craniocerebral Injury

关键词:  盐酸右美托咪定  盐酸异丙肾上腺素  颅脑损伤术  心率缓慢  不良反应

Key words:  dexmedetomidine  isoprenaline hydrochloride  craniocerebral injury postoperative  slow heart rate  adverse reaction

摘要:

目的 研究改善颅脑损伤术后盐酸右美托咪定镇静致心率缓慢不良反应的方法。方法 将盐酸右美托咪定镇静导致心率缓慢的120例患者随机分为硫酸阿托品注射液组、盐酸异丙肾上腺素组和盐酸多巴胺注射液组，各40例，观察3组药物干预后心率、目标血压、心律失常、胃钠潴留、肺部感染、目标热卡、神经元特异性烯醇化酶、胶质纤维酸性蛋白、S100B、脑氧代谢（脑氧摄取率、脑动脉-静脉血氧含量差）及对术后3个月致残率和死亡率的影响。结果 3组药物干预后，患者心率>60次/分的达标率均高。血压方面：盐酸异丙肾上腺素组的达标率较高（最低达97.5%）；硫酸阿托品注射液达标率稍低（P<0.05）；盐酸多巴胺注射液组的达标率较另2组更低（P<0.05），且心律失常的发生率明显增高（P<0.05）。与另2组相比较，硫酸阿托品注射液组发生胃钠潴留的概率明显增加（P<0.05），发生感染的概率亦明显增加，168 h目标热卡的达标率明显降低；而盐酸多巴胺注射液组与盐酸异丙肾上腺组在发生胃钠潴留、肺部感染、目标热卡达标方面无差异。3组药物干预后脑氧代谢、神经功能因子、3月后死亡率及致残率未见明显差异。结论 盐酸异丙肾上腺素、硫酸阿托品注射液、盐酸多巴胺注射液具有改善盐酸右美托咪定镇静所导致心率缓慢的作用，其中盐酸异丙肾上腺素改善心率减慢的不良反应小，可供临床推荐应用。

Abstract:

OBJECTIVE To study the methods to improve the adverse reaction of slow heart rate induced by dexmedetomidine hydrochloride, which is used for sedation after craniocerebral injury surgery. METHODS The 120 patients who had low heart rate induced by dexmedetomidine hydrochloride were randomly divided into three groups, including atropine sulfate injection group, isoproterenol hydrochloride group and dopamine hydrochloride injection group. Each group contained 40 cases. The heart rate, the goal blood pressure, arrhythmia, gastric retention, pulmonary infection, the goal heat card, neuron-specific enolase, glial fibrillary acidic protein S100B, cerebral extraction of oxygen and cerebral artery-venous oxygen content difference were observed in three groups after drug intervention, as well as the morbidity and mortality at 3 months after surgery. RESULTS After drug intervention, the compliance rate of heart rate >60 times per minute of three groups was higher. In terms of the goal blood pressure, isoproterenol hydrochloride group had a higher completion rate(minimum 97.5%), meanwhile the completion rate of the atropine sulfate injection group was slightly lower(P<0.05). The compliance rate of goal blood pressure of dopamine hydrochloride injection group was lower than other 2 groups(P<0.05), and the incidence of arrhythmia was obviously higher than other groups(P<0.05). Compared with other 2 groups, the probability of gastric retention as well as infection in atropine sulfate injection group increased significantly(P<0.05); the compliance rate of 168 h goal calories was significantly decreased. The dopamine hydrochloride injection group and isoproterenol hydrochloride group had no significant difference in gastric retention, infection and compliance rate of goal calories. There were no obvious different in cerebral oxygen metabolism, nerve function factors, mortality and disability rate at 3 months after drug intervention among the three groups. CONCLUSION Isoproterenol hydrochloride, atropine sulfate injection and dopamine hydrochloride injection can improve the cardiac slowdown caused by dexmedetomidine sedation, while isoprenaline hydrochloride has the least adverse reaction, which can be recommended for clinical application.