摘要
目的探讨术前焦虑对经鼻给予右美托咪定(IN-Dex)调节心血管自主神经活性的影响。方法择期手术患者104例,根据阿姆斯特丹术前焦虑和信息量表(APAIS)评分将患者分为术前焦虑组(A组,APAIS评分≥11分,39例)和无术前焦虑组(B组,APAIS评分<11分,65例)。两组患者均IN-Dex 1.0μg/kg,观察30.0 min。记录两组患者一般资料,给药前5.0 min及给药后5.0、10.0、15.0、20.0、25.0、30.0 min的低频功率(LH)、高频功率(HF)、LF/HF,给药前5.0 min及给药后2.5、5.0、7.5、10.0、12.5、15.0、17.5、20.0、22.5、25.0、27.5、30.0 min的心率、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、外周灌注指数(PPI),给药前5.0 min及给药后30.0 min的Ramsay镇静评分、APAIS评分,并分析给药前5.0 min APAIS评分与给药后30.0 min Ramsay镇静评分的相关性,不良反应(呼吸抑制、低血压和窦性心动过缓)发生情况。结果两组患者一般资料差异无统计学意义(均P>0.05)。与B组比较,A组患者给药后15.0 min的LF较低(P<0.05);与给药前5.0 min比较,两组患者给药后5.0、10.0、15.0、20.0、25.0、30.0 min LF、LF/HF降低(均P<0.05),A组患者给药后25.0、30.0 min及B组患者给药后20.0、25.0、30.0 min HF升高(均P<0.05)。与B组比较,A组患者给药前5.0 min及给药后各时点PPI均较低(均P<0.05);与给药前5.0 min比较,两组患者给药后各时点PPI升高(均P<0.05);两组患者给药后PPI比较结果显示,组别与时点之间存在显著的交互效应(F=7.87,P<0.001),B组患者PPI的升高幅度大于A组(均P<0.05)。与B组比较,A组患者给药前5.0 min及给药后各时点心率较高(均P<0.05),给药后5.0、15.0、20.0、27.5、30.0 min SBP较高(均P<0.05),给药后2.5、5.0、7.5、12.5、15.0、17.5、22.5、25.0、27.5、30.0 min DBP较高(均P<0.05),给药后2.5、17.5、22.5 min MAP较高(均P<0.05);与给药前5.0 min比较,两组患者给药后5.0、7.5、10.0、12.5、15.0、17.5、20.0、22.5、25.0、27.5、30.0 min SBP下降,给药后各时点心率、DBP、MAP均下降(均P<0.05)。给药前5.0 min APAIS评分与给药后30.0 min Ramsay镇静评分呈显著负相关(r=-0.402,P<0.001)。两组患者均无呼吸抑制、低血压、窦性心动过缓等不良反应发生。结论IN-Dex是有效调节心血管自主神经活性的方法,术前焦虑减弱IN-Dex改善外周血流灌注的作用。
Objective To explore the effect of preoperative anxiety on the modulation of cardiovascular autonomic nervous activity by intranasal dexmedetomidine(IN‑Dex).Methods A total of 104 patients undergoing elective surgery were selected.According to the Amsterdam Preoperative Anxiety and Information Scale(APAIS)score,they were divided into two groups:a preoperative anxiety group(group A,APAIS score≥11,n=39)and a non‑preoperative anxiety group(group B,APAIS score<11,n=65).Both groups received IN-Dex at 1.0μg/kg and were observed over 30.0 min.Their general information was recorded.Meanwhile,low‑frequency power(LH),high‑frequency power(HF),and LF/HF at 5.0 min before administration,and at 5.0,10.0,15.0,20.0,25.0 min and 30.0 min after administration were recorded.Heart rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),and peripheral perfusion index(PPI)were recorded at 5.0 min before administration and at 2.5,5.0,7.5,10.0,12.5,15.0,17.5,20.0,22.5,25.0,27.5 min and 30.0 min after administration.Ramsay sedation score and APAIS score were measured at 5.0 min before administration and at 30.0 min after administration.The correlation between the APAIS score at 5.0 min before administration and Ramsay sedation score at 30.0 min after administration was analyzed.Adverse reactions such as respiratory depression,hypotension,and sinus bradycardia were recorded.Results There were no significant differences in general information between the two groups(all P>0.05).Compared with group B,group A had decreased LF at 15.0 min after administration(P<0.05).Compared with 5.0 min before administration,both groups showed decreased LF and LF/HF at 5.0,10.0,15.0,20.0,25.0 min and 30.0 min after administration(all P<0.05).In contrast,HF was increased at 25.0 min and 30.0 min after administration in group A,and at 20.0,25.0 min and 30.0 min after administration in group B(all P<0.05).Compared with group B,group A had decreased PPI at 5.0 min before administration and at all time points after administration(all P<0.05);both groups showed increased PPI at all time points after administration compared with 5.0 min before administration(all P<0.05).The PPI comparison between the two groups showed a significant interaction between group and time(F=7.87,P<0.001),with the increase in PPI in group B being greater than in group A(all P<0.05).Compared with group B,group A had increased heart rate at 5.0 min before administration and at all time points after administration(all P<0.05).In group A,SBP was higher at 5.0,15.0,20.0,27.5 min and 30.0 min after administration(all P<0.05),while DBP was higher at 2.5,5.0,7.5,12.5,15.0,17.5,22.5,25.0,27.5,30.0 min after administration(all P<0.05).MAP was higher at 2.5,17.5 min and 22.5 min after administration in group A(all P<0.05).Compared with 5.0 min before administration,SBP was decreased at 5.0,7.5,10.0,12.5,15.0,17.5,20.0,22.5,25.0,27.5 min and 30.0 min after administration,while heart rate,DBP,and MAP were decreased at all time points in both groups(all P<0.05).The APAIS score at 5.0 min before administration was significantly negatively correlated with the Ramsay sedation score at 30.0 min after administration(r=-0.402,P<0.001).No adverse reactions such as respiratory depression,hypotension,or sinus bradycardia occurred in either group.Conclusions IN-Dex is an effective method for modulating cardiovascular autonomic nervous activity.Preoperative anxiety weakens the effect of IN-Dex on improving peripheral blood flow perfusion.
作者
胡颖
周盈
杨夏霖
管金萍
杜泽路
徐开兴
张军龙
Hu Ying;Zhou Ying;Yang Xialin;Guan Jinping;Du Zelu;Xu Kaixing;Zhang Junlong(Department of Anesthesiology,Lianyungang Clinical College,Xuzhou Medical University,Lianyungang 222006,China;Department of Anesthesiology,Lianyungang Hospital,Jiangsu University,Lianyungang 222023,China;Department of Anesthesiology,Jinshan Hospital of Fudan University,Shanghai 201508,China)
出处
《国际麻醉学与复苏杂志》
2026年第1期34-39,共6页
International Journal of Anesthesiology and Resuscitation
关键词
自主神经
术前焦虑
外周灌注指数
经鼻给予右美托咪定
Autonomic nervous
Preoperative anxiety
Peripheral perfusion index
Intranasal dexmedetomidine
