摘要
目的:观察右美托咪定(dexmedetomidine,Dex)对下肢手术使用止血带的血流动力学的影响。方法:选择择期在我院行下肢手术的患者60例,ASA I～Ⅱ级,随机分为2组,即右美托咪定组(dexmedetomidine,D组)和对照组(control,C组),每组30例,两组均选择腰硬联合麻醉。麻醉成功后,D组于上止血带前15 min,用微量泵给予Dex负荷量0.8μg/kg,10 min静脉泵入,之后输注速度设定为0.4μg.kg-1.h-1,直至止血带放气;C组用生理盐水代替右美托咪定,用药方法同D组。记录两组药物给负荷量之前(T0)、止血带充气前(T1)、止血带充气后15 min(T2)、止血带充气后30 min(T3)、止血带充气后45 min(T4)、止血带充气后60 min(T5)及止血带放气后5 min(T6)的平均动脉压(MAP)、心率(HR)及血氧饱和度(SPO2);记录两组高血流动力学的发生率及所用血管活性药物的量。结果 :用药前,两组患者的MAP、HR及SPO2比较,差异均无统计学意义(P>0.05)。D组患者给予负荷量后,T2～T5各时点MAP均较T1显著升高(P<0.05),而T6时MAP下降,与T1比较无明显差异(P>0.05);T4～T6各时点HR均较T1显著升高(P<0.05),各时点SPO2比较均无统计学意义(P>0.05)。C组在T2～T6各时点MAP和HR均较T1显著升高(P<0.05),各时点SPO2比较均无统计学意义(P>0.05)。T2、T4和T6各时点D组患者的MAP具显著低于C组(P<0.05),T1～T6各时点HR均显著低于C组(P<0.05)。D组T1时HR显著低于T0时(P<0.05)。C组和D组患者高血流动力学反应的发生率分别为66.7%和20%,C组明显高于D组(P<0.01)。两组患者尼卡地平和阿托品的用量差异均无统计学意义(P>0.05),但D组麻黄碱的用量明显高于C组(P<0.0 5),两组患者均未应用艾司洛尔处理。结论:Dex可减少下肢手术使用止血带时引起的血流动力学高反应的发生。
Objective： To evaluate the effects of dexmedetomidine on the tourniquet-induced hyperdynamic response during combined spinal anesthesia （CSEA）. Methods： 60 patients ofASA I - II undergoing lower limb surgeries Utider CSEA were allocated randomly into two groups, 30 cases in each group： dexmedetomidine group （Group D） and control group （Group C）. Unddr CSEA, the group D was received a loading dose of dexmedetomidine （0.8 μg/kg, over 10 min） followed by continuous infusion of dexmedetomidine （0.4 μg .kg .h^-1） until tourniquet deflation. The group C received normal saline instead. Tourniquet-induced changes in hettiodynatrlic parameters, including heart rate （HR）, mean arterial pressure （MBP） were compared between two groups. ResUlts： Before drug administration, no significant difference of hemodynamic parameters, including HR, MAP and SPO2 was observed between the two groups （P〉0.05）. MAP of group D at T2, T3, T4 and T5 were significantly higher than that of T1 after a bolus dose of dexmedetomidine （0.8 μg/kg） （P〈0.05）, which was lower slightly at T6 than that at T 1 （P〉0.05）. HR of group D at T4, T5 and T6 were significantly higher than that at T1, and it was significantly lower at TI than that at TO after a bolus dose of dexmedetomidine （0.8 μg/kg） （P〈0.05）. MAP and HR of group C at T2, T3, T4, T5 and T6 were higher than that at T1 （P〈0.05）. MAP of group D at T2, T4 and T6 were lower than than of group C（P〈0.01）. HR of group D from T1 to T6 were lower than that of group C（P〈0.05）. The incidence of hyperdynamic response iti the group C was significantly higher than that in the group D （66.7% versus 20.0%; P〈0.01）. The total consumption of nieardipine and atropine was comparable in these two groups （P〉0.05）. Howe^cer, the total ephedrine consumption was higher in group D than in group C （P〈0.05） None of the cases received esmolol. Conclusion： Dexmedetomidine attenuated tourniquet-induced hyperdynamic response in combined spinal anesthesia patients undergoing lower limb surgeries.
出处
《现代生物医学进展》
CAS
2013年第11期2096-2099,共4页
Progress in Modern Biomedicine
基金
2012年十堰市科学技术研究与开发项目计划(078S)
