右美托咪定辅助控制性降压联合高容量血液稀释在脊柱手术中的应用

发布时间：2018-02-10 19:58

本文关键词： 右美托咪定控制性降压高容量血液稀释脊柱手术　出处：《中国药房》2015年23期 　论文类型：期刊论文

【摘要】：目的:探讨右美托咪定辅助控制性降压联合高容量血液稀释在脊柱手术中应用的安全性、优越性和可靠性。方法:将进行全身麻醉下脊柱手术患者40例采用随机数字表法分为右美托咪定组(D组)和生理盐水组(S组),各20例。两组均给予控制性降压联合高容量血液稀释的方法进行血液保护以及术中唤醒试验。其中,D组患者在麻醉诱导开始之前10min用微量泵在10min内输入1μg/kg右美托咪定,控制性降压期间以0.4~0.8μg/(kg·h)维持输注,唤醒试验和麻醉维持期间以0.2μg/(kg·h)输注至拔出气管导管;S组患者将右美托咪定换成生理盐水,泵注方法同D组。观察并记录患者泵注药品前(T0)、气管插管后1 min(T1)、麻醉诱导后10 min(T2)、麻醉诱导后30 min(T3)、唤醒时(T4)、控制性降压停止时(T5)、术毕时(T6)、拔出气管导管时(T7)的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP),同时记录两组患者的唤醒试验时间、唤醒时出血量、硝酸甘油总量、异氟醚平均吸入浓度、瑞芬太尼总量、总出血量、术毕苏醒时间。统计两组患者术后发生苏醒延迟、寒战、烦躁的例数。结果:两组患者在T1、T7时的HR均较T0时加快,MAP、CVP均较T0时升高,且S组较D组明显(P0.05);两组患者在T3时的HR、MAP较T0时明显降低(P0.05);S组患者在T4时的MAP、CVP较T0时以及D组T4时升高,HR加快(P0.05)。D组患者的唤醒试验时间、术毕苏醒时间短于S组(P0.05),唤醒时出血量、总出血量少于S组(P0.05),硝酸甘油总量、异氟醚平均吸入浓度、瑞芬太尼总量小于S组(P0.05);D组术后苏醒延迟、烦躁、寒战的发生率明显低于S组(P0.05)。结论:右美托咪定辅助控制性降压联合高容量血液稀释在脊柱手术中应用,使控制性降压更有效、稳定,能明显减少硝酸甘油、瑞芬太尼、丙泊酚、异氟醚的用量,是辅助控制性降压联合高容量血液稀释在脊柱手术中应用的安全、可靠的药物。
[Abstract]:Objective: to investigate the safety of dexmetomidine combined with hypervolemic hemodilution in spinal surgery. Methods: 40 patients undergoing spinal surgery under general anesthesia were randomly divided into dexmetomidine group (group D) and normal saline group (group S, n = 20). Both groups were given controlled hypotension. Hypervolemic hemodilution was used for blood protection and intraoperative arousal test. Patients in group D received 1 渭 g / kg dexmetidine 10 minutes before anesthesia induction with a micropump within 10 minutes. During controlled hypotension, infusion was maintained at 0.4 渭 g / kg 路h, followed by 0.2 渭 g / g / kg 路h during arousal test and anesthesia maintenance. The patients in the tracheal duct group S were treated with dexmetomidine instead of normal saline. The method of pump injection was the same as that in group D. the heart rate of the patients was observed and recorded before and after infusion of drugs, 1 min after tracheal intubation, 10 min after induction of anesthesia, 30 min after induction of anesthesia, 30 min after induction of anesthesia, 30 min after anesthesia induction, 30 min after anesthesia induction, 30 min after anesthesia induction, 30 min after arousal, 1 minute after controlled hypotension, when T5 was stopped, when T6 was completed, and when tracheal catheter was pulled out (T7). HRP, mean arterial pressure MAPP, central venous pressure CVP, and the arousal test time of the two groups were recorded at the same time. The amount of bleeding, the total amount of nitroglycerin, the average inhaled concentration of isoflurane, the total amount of remifentanil, the total amount of bleeding, the time of recovery after operation were analyzed. Results: HR at T1T7 was higher than that at T0, and CVP of MAPP was higher than that of T0. HRMAP at T3 was significantly lower in group S than in group D than in group D, and MAPV CVP in group S at T4 was significantly lower than that in group T 4, and in group D, the time of arousal test in group P0.05 was accelerated by increasing the level of MAPV CVP at T4 and T4 in group D, and HRMAP in group T 3 was significantly lower than that in group T 0, and that in group D was significantly higher than that in group D at T 4. The recovery time after operation was shorter than that in group S (P 0.05), and the total amount of bleeding during awakening was less than that in group S (P 0.05), the total amount of nitroglycerin and the average inhaled concentration of isoflurane, and the total amount of remifentanil was less than that in group S (P 0.05). The incidence of shivering was significantly lower than that in group S (P 0.05). Conclusion: dexmetomidine combined with high volume hemodilution in spinal surgery can make controlled hypotension more effective and stable, reduce nitroglycerin, remifentanil, and remifentanil. The dosage of propofol and isoflurane is a safe and reliable drug used in spinal surgery combined with controlled hypotension and high volume hemodilution.
【作者单位】：武威市凉州区第三人民医院麻醉科;
【分类号】：R614

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