右美托咪啶控制性降压对膝关节置换术效果的临床分析  

Clinical analysis of controlled hypotension with dexmede-tomidine effect on knee replacement operation

作　　者：赵若光[1] 林莹[1] 邹聪华[1] 陈彦青[1] 

机构地区：[1]福建省立医院麻醉科,福州350001

出　　处：《福建医药杂志》2015年第3期85-87,共3页Fujian Medical Journal

摘　　要：目的探讨应用右美托咪啶行控制性降压对膝关节置换术的影响。方法择期行单侧全膝关节置换手术患者40例（ASAI～Ⅱ级，年龄55～68岁，体质量47～72kg），随机分为两组（n=20）：止血带组（I组）和右美托咪啶控制性降压组（II组）。两组均采用腰硬联合麻醉，I组于切皮前开始使用止血带，缝皮前停止使用；Ⅱ组于麻醉诱导前30min泵注右美托眯啶lμg／kg（10min泵入）后以0．5μg／（kg·h）持续泵人。于人手术室安静状态下（T0）、麻醉后（T1）、切皮后（T2）和术后（T3）记录患者的HR、MAP和血气分析的乳酸值，统计患者术中出血量、手术时间及不良反应发生率及术后24、48、72h出血量等。结果与I组比较，Ⅱ组T1～TsHR、T2～T3MAP、T3乳酸值明显降低（P值均〈0．05），手术时间、术中出血量，术后24、48、72h出血量无明显改变（P值均〉0．05）。两组不良反应发生率无明显变化（P〉0．05）。结论膝关节置换术中应用右美托咪定控制性降压可减少术中出血量，避免止血带引起的局部组织缺血缺氧，同时不影响血流动力学稳定，不增加不良反应的发生率。Objective To investigate the effects of controlled hypotension with dexmedetomidine on perioperative knee replacement operation. Methods Choose 40 cases of knee replacement operation patients, ASA Grade I to Grade Ⅱ , age 55 to 68 years of age, body weight 47 to 72 kg. In total, 40 patients were randomly divided into two groups （n= 20） ： tourniquet group （Group I ） and dexmedetomidine group （Group Ⅱ ）. Two groups were treated with combined spinal epidural anesthesia, Group I began using tourniquet before the skin incision, stop before the suture of skin , Group Ⅱ administratered dexmedeto- midine 1 μg/kg （10 min pump） 30min before anesthesia, then 0.5 μg/kg/h pumping continuously. After entering operation room （T0）, after anesthesiathe （T1）, after skin incision （T2）, operation ending （Ta）, HR , MAP and the lactic acid were re- corded, and record the blood loss, the operation time and the incidence of adverse reaction. Record the blood loss 24 h postoper- ative, 48 h postoperative and 72 h postoperative. Results Compared with Group I , Group Ⅱ was significantly lower in HR at T1-3, lower at T2-3 in MAP, lower at T3 in the lactic acid; Compared with Group I , the difference in bloodloss and operation time had no significant difference （P〉0.05）. The adverse reactions of each group had no significant difference （P〉0.05）. Con- clusion During knee replacement operation, controlled hypotension with dexmedetomidine can reduce operative blood loss, a- void local ischemia and hypoxia with tourniquet, and does not affect the stability of hemodynamics, not increase the incidence of adverse reaction.

关 键 词：右美托咪啶 控制性降压 膝关节置换 

分 类 号：R614[医药卫生—麻醉学]