右美托咪定复合七氟烷控制性低血压对脊柱后路手术患者肾素-血管紧张素-醛固酮系统的影响

发布时间：2018-06-16 12:53

  本文选题：右美托咪定 + 七氟烷　； 参考：《广东医学》2015年10期

【摘要】：目的观察右美托咪定(Dex)复合七氟烷在脊柱后路手术中控制性低血压的效果,比较Dex和硝普钠对患者肾素-血管紧张素-醛固酮系统(RAAS)的影响。方法选择术中需行控制性低血压的脊柱后路手术患者60例(ASAⅠ或Ⅱ级),气管插管后,控制呼气末七氟烷浓度为(2.0±0.5)%。按降压方法将患者分为N组和D组,每组30例,均使平均动脉压(MAP)降低至基础值的60%~70%(目标血压)。N组:患者放置俯卧位后开始持续避光泵注0.1%硝普钠,以0.5μg/(kg·h)速度开始,根据MAP调整剂量。D组:患者放置俯卧位后开始泵注负荷量Dex 1.0μg/kg(稀释至20 m L以120 m L/h速度10 min泵注完毕),继以0.2~0.8μg/(kg·h)(浓度4μg/m L)泵注维持,根据MAP调整速度。记录麻醉诱导前(T0)、控制性低血压前即刻(T1)、控制性低血压后15min(T2)、控制性低血压后30 min(T3)、控制性低血压结束后20 min(T4)的心率(HR)、MAP、达目标血压时间、控制性低血压持续时间、手术时间、出血量及尿量、术野质量评分(SSFQ),同时测定血浆中肾素、血管紧张素Ⅱ、醛固酮含量。由同一术者在不知道控制性低血压方式的情况下评估术野质量。结果两组患者年龄、体重、性别比、控制性低血压持续时间、手术时间组间比较,差异无统计学意义(P0.05)。所有患者术中MAP均能维持在目标范围。N组T2~T4的HR较T0和T1增加(P0.05);D组T2~T4的HR较T0和T1减慢(P0.05),也较N组T2~T4的慢(P0.05);N组T4的MAP较T0高,也高于D组T4(P0.05);D组T4的MAP较T0无明显变化,差异无统计学意义(P0.05)。N组T2~T4肾素、血管紧张素Ⅱ、醛固酮含量高于T0和T1(P0.05),也高于D组相应时点(P0.05)。D组T2~T4肾素、血管紧张素Ⅱ、醛固酮含量低于T0和T1(P0.05)。D组的出血量明显较N组少(P0.05),尿量较N组多(P0.05),SSFQ低于N组(P0.05)。结论与硝普钠相比,Dex复合七氟烷控制性低血压过程平稳,无心动过速和高血压反跳,能使手术视野更清晰,并在控制性低血压期间抑制RAAS。
[Abstract]:Objective to observe the effect of dexmetomidine combined with sevoflurane on hypotension control in posterior spinal surgery and to compare the effects of Dex and sodium nitroprusside on renin-angiotensin-aldosterone system. Methods A total of 60 patients undergoing posterior spinal surgery with controlled hypotension were selected. After endotracheal intubation, the concentration of sevoflurane at the end of the breath was controlled to be 2.0 卤0.5. The patients were divided into N group and D group according to the method of lowering blood pressure. Each group (30 cases) reduced the mean arterial pressure to 60% of the basic value. (target blood pressure. N group: after the patients were placed in prone position, 0.1% sodium nitroprusside was continuously injected with 0.1% sodium nitroprusside, starting with 0.5 渭 g/(kg / h). According to map adjusted dose. D group: the patients were placed in prone position and began to pump loading volume Dex 1.0 渭 g / kg (diluted to 20 mL at 120ml / h speed 10 min pump infusion), then maintained with 0.2c0. 8 渭 g/(kg hu (concentration 4 渭 g / m L) pump, adjusted the speed according to map. The heart rate (HR-MAPP) was recorded before anesthesia induction, immediately before controlled hypotension, 15 min after controlled hypotension, 30 min after controlled hypotension, 20 min after controlled hypotension. The levels of renin, angiotensin 鈪，

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