右美托咪定复合硝普钠控制性降压对脊柱手术患者肾素-血管紧张素-醛固酮系统的影响  

Effect of Dexmedetomidine-sodium Nitroprusside Induced Controlled Hypotension on Renin-angiotensin-aldosterone System of Patients Undergoing Spinal Surgery

作　　者：周其富[1] 蒋宗明[1] 郑羡河[1] 范洪辉[2] 

机构地区：[1]浙江省绍兴市人民医院麻醉科,312000 [2]浙江省绍兴市人民医院关节脊柱科,312000

出　　处：《医学研究杂志》2012年第11期158-161,共4页Journal of Medical Research

摘　　要：目的观察右美托咪定复合硝普钠在脊柱手术中行控制性降压的效果。方法择期行控制性降压的脊柱手术患者40例,按降压方法将患者随机分成硝普钠(N组)和右美托咪定复合硝普钠(D组),每组20例,使MAP较术前基础值下降30%,但不低于55mmHg。在基础值(T1)、控制性降压前即刻(T2)、控制性降压后10min(T3)、30min(T4)及控制性降压结束20min(T5)记录HR、MAP、CVP,同时测定血浆中肾素、血管紧张素Ⅱ、醛固酮浓度。由术者评估术野质量。结果 N组T3～5的HR较T1和T2明显增加(P<0.05),D组的HR无明显变化(P>0.05);N组T5的MAP、CVP高于T1,高于D组T5MAP、CVP(P<0.05),D组T5的MAP、CVP低于T1(P<0.05);肾素、血管紧张素Ⅱ、醛固酮含量两组T3～5较T1和T2增加(P<0.05或P<0.01),N组T3～5高于D组相应时点(P<0.05)。D组术野质量优于N组(P<0.05)。结论右美托咪定复合硝普钠控制性降压过程心率平稳,无反跳性高血压,为手术提供更清晰的术野,在控制性降压期间抑制RAAS的激活程度。Objective To investigate the effects of dexmedetomidine - sodium nitroprusside induced controlled hypotension on reniu - angiotensin- aldosterone system in patients undergoing spinal surgery. Methods Forty patients scheduled for spinal surgery were randomly divided into two groups （ n = 20）, receiving continuous intravenous infusion of sodium nitroprusside （ group N ） or sodium nitro- prusside in conjunction with Dexmedetomidine （ group D） to control blood pressure（ MAP was decreased by 30% of baseline, not less than 55 mm Hg）. In the following time points of baseline level （T1） , before initiation of controlled hypotension （T2 ）, 10min （T3 ） and 30min （ T4 ） after hypotension, and 20 min after termination of controlled hypotension （ T5 ） , HR, MAP and CVP were measured and plasma levels of renin （PRA） , angiotensin Ⅱ （AT - Ⅱ ） and aldosterone （ALD） were assayed. And surgical field quality score was assessed by same surgeon. Results There was faster HR at T3_sin group N, whereas it did not fluctuate markedly in group D. In comparison with parame- ters at T1, MAP and CVP increased at T5 in group N, but it was less in group D. Plasma levels of PRA, AT - Ⅱ and ALD were increased in both groups after hypotension. There were statistical significance at T3-5in group N when compared to those in group D. Operative field quality was better in group D than that in group N. Conclusion Sodium nitroprusside combined with Dexmedetomidine induced con- trolled hypotension provides stable hemodynamics（ stable HR and no rebound of hypotension）and ideal surgical access to spinal surgery, at the same time, inhibits RAAS system activation.

关 键 词：右美托咪定 硝普钠 降压 控制性 肾素-血管紧张素-醛固酮系统 

分 类 号：R541.61[医药卫生—心血管疾病]