氢化泼尼松与甲氧明对老年患者髋关节置换术中血流动力学的影响

发布时间：2018-05-06 19:14

本文选题：髋关节置换术 + 氢化泼尼松　；参考：《山东医药》2017年37期

【摘要】：目的探讨预防性使用氢化泼尼松与甲氧明对老年患者髋关节置换术中血流动力学的影响。方法选择行髋关节置换术老年患者60例,采用随机数字表法分为三组C组、MI组和MP组各20例。三组均给予全麻,于骨水泥灌注前均给予氢化泼尼松0.5 mg/kg静滴。骨水泥灌注前1 min,C组、MI组分别给予生理盐水1 m L、甲氧明1mg静注;MP组给予甲氧明负荷剂量100μg经微量泵静脉输注,之后以1~2μg/(kg·min)持续泵注10 min。记录三组麻醉前5 min(T0)、骨水泥灌注前1 min(T_1)及骨水泥灌注后1 min(T_2)、3 min(T_3)、5 min(T_4)、10 min(T_5)、15 min(T_6)SBP、DBP、平均动脉压(MAP)、HR,并测定动脉血乳酸(Lac)。记录三组术中发生的低血压、心动过缓、心动过速及术后恶心呕吐、围术期心血管事件。结果与T_1时比较,C组T_2、T_3、T_4时SBP、DBP、MAP降低,T_3、T_4、T_5时HR升高(P均0.05);MI组T_2时HR,T_4时SBP、DBP、MAP降低(P均0.05);MP组T_2、T_3、T_4、T_5、T_6时各时点SBP、DBP、MAP、HR比较,P均0.05。与T_1时比较,C组T_4、T_5时Lac水平升高(P均0.05);MI组T_5时Lac水平升高(P均0.05);MP组T_4、T_5、T_6各时点Lac水平比较,P均0.05。C组低血压发生率高于MI组、MP组(P均0.05),MI组心动过缓发生率高于MP组(P0.05),三组心动过速、围术期心血管事件发生率比较差异无统计学意义(P均0.05)。结论骨水泥灌注前预防性应用氢化泼尼松与甲氧明可有效维持老年患者人工髋关节置换术中血流动力学的稳定;且甲氧明持续静脉泵注变速给药较单次静脉注射给药对HR的影响更小。
[Abstract]:Objective to investigate the effect of prophylactic use of prednisone and methoxifen on hemodynamics during hip arthroplasty in elderly patients. Methods Sixty elderly patients undergoing hip arthroplasty were randomly divided into three groups: group C (n = 20) and group MP (n = 20). All the three groups were given general anesthesia and hydroprednisone 0.5 mg/kg intravenous drip before bone cement perfusion. The MI group was given 1 mL normal saline one minute before the bone cement perfusion, and 100 渭 g methoxifen loading dose was injected intravenously through a micropump in the MP group with methoxifen 1mg, and then continued to be pumped for 10 minutes with 1 渭 min 2 渭 g/(kg min. Five minutes before anesthesia and one minute before bone cement perfusion were recorded in the three groups, and 1 minute after the infusion of bone cement, 1 minute after the infusion of bone cement, the two groups were recorded, and 1 min after the infusion of bone cement, 3 minutes after the infusion of bone cement, 3 mins, 5 mins, 15 mins, T6, SBP, DBP, HRs of arterial blood lactic acid, were measured. The incidence of hypotension, bradycardia, tachycardia, postoperative nausea and vomiting, perioperative cardiovascular events in the three groups were recorded. Results compared with T _ 1, SBPDBPU map decreased at T _ 2T _ 3 / T _ 4 in C group and increased at T _ (3) T _ (4) T _ (5) / T _ (5) T _ (5) T _ (all) T _ (2) T _ (map) in T _ (2) T _ (3) T _ (3) T _ (3) T _ (3) T _ (4) T _ 4 / T _ (5) T _ 6 in T _ 2T _ 3 / T _ 4 / T _ (5) in T _ 6 compared with 0.05 in T _ 2T _ (3) T _ (3) T _ (4) T _ 4 / T _ (5) / T _ (6). The level of Lac in group C was higher than that in group T _ 4 and T _ 5. The level of Lac in group T _ 5 was higher than that in group T _ 5. The Lac level in group T _ (4) and T _ (5) T _ (6) was higher than that in group (P = 0.05), and the incidence of bradycardia in group P was higher than that in group MP (P = 0.05), and the incidence of bradycardia in group C was higher than that in group MP (P < 0.05), and the incidence of bradycardia in group T _ (0.05) was higher than that in group M (P < 0.05). There was no significant difference in the incidence of cardiovascular events in perioperative period (P < 0.05). Conclusion the prophylactic application of prednisone and methoxifen before bone cement perfusion can effectively maintain the hemodynamic stability in the elderly patients undergoing hip replacement. The effect of continuous intravenous infusion of methoxifen on HR was less than that of single intravenous injection.
【作者单位】：武汉大学中南医院;十堰市太和医院;
【分类号】：R687.4

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