两种不同药物组合行控制性降压用于老年患者髋关节置换术的效果比较

发布时间：2018-05-31 00:09

本文选题：硝普钠 + 右美托咪定　；参考：《中国现代医学杂志》2015年19期

【摘要】：目的评价右美托咪定与拉贝洛尔联合硝普钠控制性降压用于老年患者髋关节置换术的临床效果。方法 80例择期行髋关节置换术老年患者随机分右美托咪定+硝普钠组(D组)和拉贝洛尔+硝普钠(L组)各40例,切皮前即开始行控制性降压。观察术中血流动力学变化、手术情况、耐药及降压药物相关不良心血管事件,记录麻醉药物及降压药物用量,并在几个主要时点采集动脉血测定血乳酸(Lac)、血糖(BG)及皮质醇(Cor)浓度。结果降压20 min后,D组心率(HR)、平均动脉压(MAP)和中心静脉压(CVP)下降均较L组明显(P0.01);停止降压后D组HR、MAP和CVP均无明显反跳(P0.01)。D组硝普钠及丙泊酚用量、术中失血量和补液量少于L组(P0.05,P0.01),尿量多于L组(P0.05),术野质量优于L组(P0.01)。L组BG和Cor升高较D组明显(P0.01)。结论右美托咪定联合硝普钠在老年患者髋关节置换术中控制性降压效果较拉贝洛尔联合硝普钠理想,前者能更有效抑制应激反应,且术中麻醉药物作用量及失血量更少,但应警惕心动过缓及低血压等不良反应。
[Abstract]:Objective to evaluate the clinical effect of dexmetomidine and Labe combined with sodium nitroprusside in the treatment of hip arthroplasty in elderly patients. Methods 80 elderly patients undergoing hip arthroplasty were randomly divided into two groups: right metomidine sodium nitroprusside group (n = 40) and Labe group (n = 40). The changes of hemodynamics, the condition of operation, the adverse cardiovascular events associated with drug resistance and antihypertensive drugs were observed, and the dosage of anesthetic and antihypertensive drugs were recorded. Arterial blood samples were collected at several time points to determine the concentration of Lactol lactate, BGG and Corr. Results after 20 min of hypotension, the heart rate, mean arterial pressure (MAPP) and central venous pressure (CVP) in group D were significantly lower than those in group L (P 0.01), and the levels of sodium nitroprusside and propofol in group D were not significantly increased after stopping the hypotension, and the levels of sodium nitroprusside and propofol were not significantly increased in group D. The volume of blood loss and fluid replacement in group L was less than that in group L (P 0.05) and the volume of urine was higher than that in group L (P 0.05). The quality of operative field was better than that in group L (P 0.01). The increase of BG and Cor in group L was significantly higher than that in group D (P 0.01). Conclusion the controlled hypotension effect of dexmetomidine combined with sodium nitroprusside is better than that of Labe combined with sodium nitroprusside in elderly patients with hip arthroplasty. The former is more effective in inhibiting stress response, and the amount of anesthetic action and blood loss during operation is less than that of dexmetomidine combined with sodium nitroprusside. But should guard against bradycardia and hypotension and other adverse reactions.
【作者单位】：钦州市第二人民医院麻醉科;中南大学湘雅二医院麻醉科;
【分类号】：R614

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