臂丛神经阻滞下上肢骨科手术患者中右美托咪定引起的血流动力学不稳定：一项回顾性研究。
Dexmedetomidine-induced hemodynamic instability in patients undergoing orthopedic upper limb surgery under brachial plexus block: a retrospective study.
机构信息
Department of Anesthesiology and Pain Medicine, Jeonbuk National University Hospital and Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeollabuk-do, South Korea.
Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.
出版信息
BMC Anesthesiol. 2021 Sep 16;21(1):207. doi: 10.1186/s12871-021-01416-4.
BACKGROUND
Hemodynamic instability is a frequent adverse effect following administration of dexmedetomidine (DMED). In this study, we evaluated the incidence of DMED-induced hemodynamic instability and its predictive factors in clinical regional anesthesia practice.
METHODS
One hundred sixteen patients who underwent orthopedic upper limb surgery under brachial plexus block with intravenous DMED administration were retrospectively identified. The primary outcome was the incidence of DMED-induced hemodynamic instability. The participants were allocated to a stable or unstable group by their hemodynamic instability status. Patients' characteristics were compared between the groups. The relationship between the potential risk factors and development of DMED-induced hemodynamic instability was analyzed with a logistic regression model.
RESULTS
DMED-induced hemodynamic instability was observed in 14.7% of patients (17/116). The unstable group had more women than the stable group (76.5% vs. 39.4%, P = 0.010). When patients were classified into four subgroup according to body mass index (underweight, normal weight, overweight, and obesity), there was significant difference in the composition of the subgroups in the two groups (P = 0.008). In univariate analysis, female sex, obesity, and pre-existing hypertension were significant predictors of DMED-induced hemodynamic instability. Multivariate analysis demonstrated that female sex (adjusted OR 3.86, CI 1.09; 13.59, P = 0.036) and obesity (adjusted OR 6.41, CI 1.22; 33.57, P = 0.028) were independent predictors of DMED-induced hemodynamic instability.
CONCLUSIONS
Female and obese patients are more likely to have hemodynamic instability following intravenous DMED administration in clinical regional anesthesia practice. This study suggests that DMED dose may be diminished to prevent hypotensive risk in these populations.
TRIAL REGISTRATION
This article was retrospectively registered at WHO clinical trial registry platform (Trial number: KCT0005977 ).
背景
接受右美托咪定（DMED）治疗后出现血流动力学不稳定是一种常见的不良反应。本研究评估了 DMED 在临床区域麻醉实践中引起血流动力学不稳定的发生率及其预测因素。
方法
回顾性确定了 116 名接受臂丛神经阻滞下静脉内 DMED 给药的骨科上肢手术患者。主要结局为 DMED 引起的血流动力学不稳定的发生率。根据血流动力学不稳定状态将参与者分为稳定组或不稳定组。比较两组患者的特征。使用逻辑回归模型分析潜在危险因素与 DMED 引起的血流动力学不稳定之间的关系。
结果
14.7%（17/116）的患者出现 DMED 引起的血流动力学不稳定。不稳定组的女性多于稳定组（76.5%比 39.4%，P=0.010）。当根据体重指数（体重过轻、正常体重、超重和肥胖）将患者分为四个亚组时，两组的亚组构成存在显著差异（P=0.008）。在单因素分析中，女性、肥胖和既往高血压是 DMED 引起的血流动力学不稳定的显著预测因素。多因素分析表明，女性（调整后的 OR 3.86，CI 1.09；13.59，P=0.036）和肥胖（调整后的 OR 6.41，CI 1.22；33.57，P=0.028）是 DMED 引起的血流动力学不稳定的独立预测因素。
结论
在临床区域麻醉实践中，女性和肥胖患者在静脉内给予 DMED 后更有可能出现血流动力学不稳定。本研究表明，在这些人群中，可能需要减少 DMED 剂量以预防低血压风险。
试验注册
本文在世界卫生组织临床试验注册平台（注册号：KCT0005977）进行了回顾性注册。
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