Zeng Sisi, Wan Jixiang, Li Xuechao, Wang Na, Li Jiabei, Gao Luyue, Yang Zhen, Wang Fangjun
Department of Anaesthesiology, Affiliated Hospital of North Sichuan medical college, Nanchong, Sichuan, China.
Department of Anaesthesiology, Xinqiao Hospital of Chongqing, Second Affiliated Hospital of Army Medical University, Chongqing, China.
Sci Rep. 2025 Jan 7;15(1):1156. doi: 10.1038/s41598-025-85299-2.
The effect of epidural infusion of dexmedetomidine on haemodynamics is unclear. This study aimed to explore the effects of epidural or intravenous infusion of dexmedetomidine on haemodynamics during lower extremity varicose veins surgery (saphenectomy) under epidural anaesthesia. Ninety patients were randomly allocated to three groups: ED group (epidural: 0.59% ropivacaine plus 0.5 µg/kg dexmedetomidine, intravenous: normal saline), VD group (epidural: 0.59% ropivacaine plus normal saline, intravenous: 0.5 µg/kg dexmedetomidine), or NS group (epidural: 0.59% ropivacaine plus normal saline, intravenous: normal saline). The primary outcome was the systolic blood pressure (SBP) at before anaesthesia (T) and at 5 (T), 15 (T), and 30 min (T) and 1 (T), 2 (T), 4 (T), 6 (T), and 8 h (T) after dexmedetomidine infusion. The secondary outcomes were diastolic blood pressure (DBP) and heart rate (HR) at T, plasma norepinephrine (NE), myocardial oxygen consumption (MVO) and anesthesia efficacy. Adverse reactions and other general data were also recorded. Compared with those in the NS group, the SBP at T and DBP at T were significantly lower in the ED group (P = 0.008, 0.001, 0.001, 0.001, 0.038 and P = 0.017, 0.006, 0.044, respectively), and the SBP and DBP at T were lower in the VD group (P < 0.001, 0.001, 0.001, 0.001, 0.004 and P < 0.001, 0.001, 0.001, 0.002, 0.001, 0.001, 0.001, 0.036, respectively). The SBP and DBP at T in the ED group were greater than those in the VD group (P = 0.021, 0.01 and P = 0.001, 0.011, respectively). The HR at T was lower in the ED group than in the NS group (P < 0.001, 0.021, 0.002, 0.004, respectively). Compared with that in the VD group, the HR in the ED group at T was significantly lower (P < 0.001). Anaesthesia efficiency was improved in the ED group compared with VD and NS groups. The incidence of hypotension was lower in the ED group than in the VD group (P = 0.003). The combination of 0.5 µg/kg dexmedetomidine and 0.59% ropivacaine for epidural anaesthesia provides more stable haemodynamics with a lower incidence of hypotension and improved efficiency of epidural anaesthesia in patients undergoing saphenectomy.
硬膜外输注右美托咪定对血流动力学的影响尚不清楚。本研究旨在探讨硬膜外或静脉输注右美托咪定对硬膜外麻醉下行下肢静脉曲张手术（大隐静脉切除术）患者血流动力学的影响。90例患者随机分为三组：ED组（硬膜外：0.59%罗哌卡因加0.5μg/kg右美托咪定，静脉：生理盐水）、VD组（硬膜外：0.59%罗哌卡因加生理盐水，静脉：0.5μg/kg右美托咪定）或NS组（硬膜外：0.59%罗哌卡因加生理盐水，静脉：生理盐水）。主要观察指标为麻醉前（T）、右美托咪定输注后5分钟（T）、15分钟（T）、30分钟（T）以及1小时（T）、2小时（T）、4小时（T）、6小时（T）和8小时（T）的收缩压（SBP）。次要观察指标为T时的舒张压（DBP）、心率（HR）、血浆去甲肾上腺素（NE）、心肌氧耗（MVO）及麻醉效果。同时记录不良反应及其他一般资料。与NS组相比，ED组T时的SBP及DBP显著降低（P分别为0.008、0.001、0.001、0.001、0.038和P为0.017、0.006、0.044），VD组T时的SBP及DBP也降低（P分别<0.001、0.001、0.001、0.001、0.004和P分别<0.001、0.001、0.001、0.002、0.001、0.001、0.001、0.036）。ED组T时的SBP和DBP高于VD组（P分别为0.021、0.01和P为0.001、0.011）。ED组T时的HR低于NS组（P分别<0.001、0.021、0.002、0.004）。与VD组相比，ED组T时的HR显著降低（P<0.001）。与VD组和NS组相比，ED组的麻醉效果得到改善。ED组低血压的发生率低于VD组（P=0.003）。对于接受大隐静脉切除术的患者，0.5μg/kg右美托咪定与0.59%罗哌卡因联合用于硬膜外麻醉可提供更稳定的血流动力学，低血压发生率更低，且硬膜外麻醉效果更佳。
