Fujii Emi, Tanaka-Mizuno Sachiko, Fujino Kazunori, Fujii Masashi, Furuno Masae, Sugimoto Yasushi, Takabuchi Satoshi, Eguchi Yutaka
Department of Critical and Intensive Medicine, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu-shi, Shiga, 527-8505, Japan.
Department of Medical Statistics, Shiga University of Medical Science, Seta-tsukinowa-cho, Otsu-shi, Shiga, 527-8505, Japan.
JA Clin Rep. 2018 Sep 29;4(1):70. doi: 10.1186/s40981-018-0207-9.
Dexmedetomidine is a sedative used during spinal anaesthesia. However, it frequently induces bradycardia. Although intravenous atropine is often used for treating bradycardia during regional anaesthesia, the response to atropine might be attenuated by concomitantly administering sedatives.
We examined the effects of atropine used for treating bradycardia during spinal anaesthesia among patients receiving dexmedetomidine (D group), propofol (P group), or neither (nonDnonP group) for sedation, retrospectively.
A total of 108 patients were included. Heart rate was significantly slower at all time points in the D group (n = 69) than in the nonDnonP group (n = 14) (p < 0.025 for all). On the other hand, heart rate was significantly slower only 60 min after administration of atropine in the P group (n = 25) than in the nonDnonP group (p = 0.002). There were differences in the overall values of heart rate (including all the values from time 0 to 60 min) among the three groups (p = 0.026).
The positive chronotropic effects of atropine might be attenuated with the use of dexmedetomidine or propofol during spinal anaesthesia. Although atropine may be administered when bradycardia occurs, a dose of atropine might result in an insufficient effect against the bradycardia. The sufficient number of subjects may change the results of the investigation, and large-scale randomised controlled trials will be necessary.
右美托咪定是一种用于脊髓麻醉期间的镇静剂。然而，它经常诱发心动过缓。尽管静脉注射阿托品常用于治疗区域麻醉期间的心动过缓，但同时使用镇静剂可能会减弱对阿托品的反应。
我们回顾性研究了在接受右美托咪定（D组）、丙泊酚（P组）或两者均未使用（非D非P组）进行镇静的患者中，阿托品用于治疗脊髓麻醉期间心动过缓的效果。
共纳入108例患者。D组（n = 69）在所有时间点的心率均显著慢于非D非P组（n = 14）（所有时间点p < 0.025）。另一方面，P组（n = 25）仅在给予阿托品60分钟后的心率显著慢于非D非P组（p = 0.002）。三组之间心率的总体值（包括从0到60分钟的所有值）存在差异（p = 0.026）。
在脊髓麻醉期间使用右美托咪定或丙泊酚可能会减弱阿托品的正性变时作用。尽管心动过缓发生时可给予阿托品，但一定剂量的阿托品可能对心动过缓的效果不足。足够数量的受试者可能会改变研究结果，因此有必要进行大规模随机对照试验。
