小剂量硝酸甘油对老年股骨颈骨折患者全髋关节置换术后血流动力学及血清乳酸水平的影响

发布时间：2018-05-07 08:05

本文选题：股骨颈骨折 + 全髋关节置换术　；参考：《山东医药》2017年13期

【摘要】：目的探讨小剂量硝酸甘油对老年股骨颈骨折患者全髋关节置换术后血流动力学及血清乳酸水平的影响。方法行全髋关节置换术的老年股骨颈骨折患者60例,随机分为硝酸甘油组(N组)和对照组(C组),每组30例。N组入ICU后给予静脉泵注硝酸甘油0.25 g/(kg·min),C组则泵注等容量的生理盐水。观察并记录入ICU时(T_0)、给药后15 min(T_1)、拔管后5 min(T_2)、拔管后2 h(T_3)各时间点心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)及尿量,同时记录患者血气分析结果,血清乳酸值,并记录两组患者的拔管时间,ICU入住时间及心血管不良事件的发生情况。结果与T_0时相比,N组MAP在T_1、T_2、T_3时降低(P均0.05),但均在正常范围。与C组相比,N组T_2、T_3时MAP低(P均0.05)。与T_0时相比,N组血清乳酸在T_3时高(P0.05),C组血清乳酸在T_2、T_3时高(P均0.05)。与C组相比,N组在T_2、T_3时血清乳酸低(P均0.05)。两组各时点的HR、CVP、pH、动脉血氧分压、红细胞压积组内、组间比较,P均0.05。N组在T_3时的总尿量多于C组(P0.05)。两组拔管时间及ICU入住时间比较,P均0.05。N组有1例患者出现低血压,治疗后好转,其他患者无明显不良反应发生。结论小剂量硝酸甘油可安全用于行全髋关节置换术的老年股骨颈骨折患者,维持患者术后血流动力学稳定,改善其微循环状态,降低血清乳酸水平。
[Abstract]:Objective to investigate the effect of low dose nitroglycerin on hemodynamics and serum lactate level in elderly patients with femoral neck fracture after total hip arthroplasty. Methods Sixty elderly patients with femoral neck fracture underwent total hip arthroplasty were randomly divided into nitroglycerin group (n = 30) and control group (n = 30). Each group (n = 30) received intravenous injection of nitroglycerin 0.25 g/(kg / min group (n = 30) and saline of the same volume. To observe and record the time of ICU, 15 min after administration, 15 min after administration, 5 min after extubation, 5 min after extubation, 2 h after extubation and 2 h after extubation, the heart rate and HRP, mean arterial pressure, central venous pressure (CVP) and urine volume were observed and recorded. The results of blood gas analysis and serum lactate value were also recorded. The time of extubation and the occurrence of cardiovascular adverse events in ICU were recorded. Results compared with T _ 0, MAP in group N decreased by 0.05% at T _ 1 / T _ 2 / T _ 3, but all were within normal range. Compared with group C, MAP in group N was lower than that in group T _ 2 / T _ 3. The serum lactic acid in group N was higher than that in group C at T _ 2 / T _ 3 at T _ 2 / T _ (3) compared with that at T _ (0). Compared with group C, the serum lactic acid level in group N was 0.05% at the time of T _ 2 and T _ 3. The pH of CVP, partial pressure of oxygen in arterial blood and hematocrit in both groups were higher than those in group C at T _ 3. The total urine volume of group P 0.05.N was higher than that of group C at T _ 3. Comparison of extubation time and ICU stay time in two groups there was one patient with hypotension in group P 0.05.N, which was improved after treatment, but no significant adverse reaction occurred in other patients. Conclusion low dose nitroglycerin can be safely used in elderly patients with femoral neck fracture undergoing total hip arthroplasty. It can maintain hemodynamic stability, improve microcirculation and decrease serum lactic acid level in patients with femoral neck fracture after total hip arthroplasty.
【作者单位】：徐州医科大学附属医院;
【分类号】：R687.4

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