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1、右旋美托咪喘用于减弱电休克心血管反应的临床观察赵卫兵李艳丁启方张兵丁正年(南京医科大学,210029)【摘要】目的观察右旋美托咪噪(DEX)对电休克治疗(electroconvulsivetherapy,ECT)术后的心血管反应、抽搐发作的时间与病人的恢复的吋间的影响,以期寻找减弱电休克心血管反应的方法。方法选择ECT病人21例,随机分为三组:DEX⑴组,术前10分钟给予右旋美托咪Pze1.0ug/kgIV;DEX⑵组,术前10分钟给予右旋美托咪喘0.8Hg/kgIV;NS组,术前10分钟给予等容量牛理盐水。麻醉诱导给予丙泊酚直至动态EEG显示睡眠慢波出现或睫毛反射消失,
2、后给予司可林1mg/kg,于麻醉前、DEX给药后10分钟及电刺激后1、3、5、10分钟记录动脉血压、心率、、抽搐吋间及清醒吋间、离室吋间。结果:DEX(l)和DEX(2),与对照组相比,心率、血压在给药后10分钟,和抽搐结束后1,3,10分钊
3、有下降(P<0.05),且峰值心率、血压低于对照组。而抽搐质量与脑电抽搐吋间与对照组相比无显著差异(P>0.05),DEX(l)与DEX(2)ffl比,能明显延长病人到是口主呼吸恢复,睁眼和服从指令的时间(PV0.05),而DEX(2)与对照组和比,差异无显著性(P>0.05)o结论:在用丙泊酚麻醉诱导前,给予0.8ug/kgIV右
4、旋美托咪喘,时间超过10分钊可有助于预防ECT术后的急剧的血流动力学改变,且不改变病人的抽搐质量与苏醍时间。【关键词】右旋美托咪睫无抽搐电休克麻醉药物监测Premedicationwithdexmedetomidineattenuatesacutehyperdynamicresponsestoelectroconvulsivetherapywithoutalteringseizureduration.[Abstract]ObjectThisstudywasdesignedtoevaluatetheeftectofdexmedetomidineontheacutehyper
5、dynamicresponse,durationofseizureactivityandrecoverytimesinpatientsundergoingelectroconvulsivetherapy(ECT).andevaluatetheoptimaldosetoblocktheacutehyperdynamicresponsesandwithoutalteringtherecoverytimes・MethodsTwenty-onepatientsunderwentatotalof147ECTsessionsasacrossoverdesign.Differentdo
6、sewererandomlyallocatedtothreegroups.ThegroupofDEX(1)recivelmug/kgIVoveraperiodof10min,DEX(2)recive0.8mug/kgIVoveraperiodof10minandthegroupofNSrecivesaline3ml(control)・AnaesthesiawasinducedwithpropofoltoappropriatestatebyevaluatingthedynamicEEGandthelashreflex.thensuccinyIcholine0.5mg/kgI
7、Vwasadministered・Arterialbloodpressureandheartrate(HR)wererecordedduringthestudyperiod・HRandMAPinthedexmedetomidinegroups(includedex1anddex2)werelowerthanthatinthecontrolgroupat5and10minafterthestartofstudydruginfusion,andat1,3and10minaftertheseizureended(P<0.05).PeakHRandMAPwerelowerinth
8、edexmedetomidinegroupscomparedwiththatinthecontrolgroup(P<0.05).Bothmotorandelectroencephalography(EEG)seizuredurationinthecontrolgroupweresimilartothatinthedexmedetomidinegroups,Butdex1obviouslylengthenthetimetospontaneousbreathing,eyeopeningandobeyingcommands;dex2