Mahjoubifard Maziar, Heidari Mehdi, Dahmardeh Maryam, Mirtajani Seyed Bashir, Jahangirifard Alireza
Fellowship of Cardiac Anesthesia, Zahedan University of Medical Sciences, Zahedan, Iran.
Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Anesthesiol Res Pract. 2020 Jul 1;2020:4814037. doi: 10.1155/2020/4814037. eCollection 2020.
This clinical trial was conducted on 90 patients, aged 30-70 years, who had heart surgery. The participants were categorized into three groups. Group D received 1 g/kg intravenous dexmedetomidine in 10 minutes, group L received 1.5 mg/kg lidocaine (1%) 90 seconds before intubation, and group F received 2 g/kg fentanyl. The vital signs (HR, SBP, DBP, and MAP) were measured before intubation and 1st, 3rd, 5th, and 10th minutes after intubation. Data were analyzed with SPSS 19 software (chi-square, one-way ANOVA, or Kruskal-Wallis).
The age (=0.389) and gender distributions of patients were similar in all three groups. Dexmedetomidine significantly attenuated HR in the 3 (=0.001), 5 (=0.001), and 10 (=0.003) minutes after intervention. It also reduced the systolic blood pressure in the 5 (=0.024) and 10 (=0.006) minutes. This reduction was significantly higher in the dexmedetomidine group than that in the two other groups. In addition, dexmedetomidine caused a greater reduction in MAP in the 1 (=0.048), 5 (=0.0001), and 10 (=0.0001) minutes. . All three medications were effective in controlling HR; however, dexmedetomidine caused bradycardia in the 3, 5, and 10 minutes. Lidocaine resulted in an increase in MAP in the 1 minute after intubation; whereas, dexmedetomidine reduced MAP at the 5 and 10 minutes after intubation. Changes in blood pressure and mean arterial pressure in the fentanyl group was lower than the two other groups.
As a result, dexmedetomidine was not suitable for hemodynamic control and led to hypotension and bradycardia; on the other hand, fentanyl was more effective than two other medications in patients undergoing cardiac surgery. This trial is registered with IRCT2017013132320N1.
本临床试验针对90例年龄在30至70岁之间接受心脏手术的患者进行。参与者被分为三组。D组在10分钟内静脉注射1 g/kg右美托咪定，L组在插管前90秒静脉注射1.5 mg/kg利多卡因（1%），F组静脉注射2 g/kg芬太尼。在插管前以及插管后第1、3、5和10分钟测量生命体征（心率、收缩压、舒张压和平均动脉压）。数据采用SPSS 19软件进行分析（卡方检验、单因素方差分析或Kruskal-Wallis检验）。
三组患者的年龄（=0.389）和性别分布相似。右美托咪定在干预后第3分钟（=0.001）、第5分钟（=0.001）和第10分钟（=0.003）显著降低心率。它还在第5分钟（=0.024）和第10分钟（=0.006）降低收缩压。右美托咪定组的这种降低显著高于其他两组。此外，右美托咪定在第1分钟（=0.048）、第5分钟（=0.0001）和第10分钟（=0.0001）导致平均动脉压更大幅度的降低。所有三种药物在控制心率方面均有效；然而，右美托咪定在第3、5和10分钟导致心动过缓。利多卡因在插管后第1分钟导致平均动脉压升高；而右美托咪定在插管后第5和10分钟降低平均动脉压。芬太尼组血压和平均动脉压的变化低于其他两组。
因此，右美托咪定不适合用于血流动力学控制，并导致低血压和心动过缓；另一方面，芬太尼在心脏手术患者中比其他两种药物更有效。本试验已在IRCT2017013132320N1注册。
