两种不同药物组合行控制性降压用于老年患者髋关节置换术的效果比较  

Clinical effect comparison of two drug combinations for controlled hypotension in elderly hip replacement

作　　者：陈贤[1] 檀文好[1] 黎必万[1] 蒋丽丽[2] 

机构地区：[1]钦州市第二人民医院麻醉科,广西钦州535000 [2]中南大学湘雅二医院麻醉科,湖南长沙410011

出　　处：《中国现代医学杂志》2015年第19期107-112,共6页China Journal of Modern Medicine

摘　　要：目的评价右美托咪定与拉贝洛尔联合硝普钠控制性降压用于老年患者髋关节置换术的临床效果。方法 80例择期行髋关节置换术老年患者随机分右美托咪定+硝普钠组(D组)和拉贝洛尔+硝普钠(L组)各40例,切皮前即开始行控制性降压。观察术中血流动力学变化、手术情况、耐药及降压药物相关不良心血管事件,记录麻醉药物及降压药物用量,并在几个主要时点采集动脉血测定血乳酸(Lac)、血糖(BG)及皮质醇(Cor)浓度。结果降压20 min后,D组心率(HR)、平均动脉压(MAP)和中心静脉压(CVP)下降均较L组明显(P<0.01);停止降压后D组HR、MAP和CVP均无明显反跳(P<0.01)。D组硝普钠及丙泊酚用量、术中失血量和补液量少于L组(P<0.05,P<0.01),尿量多于L组(P<0.05),术野质量优于L组(P<0.01)。L组BG和Cor升高较D组明显(P<0.01)。结论右美托咪定联合硝普钠在老年患者髋关节置换术中控制性降压效果较拉贝洛尔联合硝普钠理想,前者能更有效抑制应激反应,且术中麻醉药物作用量及失血量更少,但应警惕心动过缓及低血压等不良反应。[ Objective ] To investigate the clinical effects of two drug combinations for controlled hypotension in hip replacement surgery of elderly patients. [ Methods ] Eighty elderly patients undergoing elective hip replacement surgery were randomly divided into group D （dexmedetomidine ＋ sodium nitroprusside, n = 40） and group L （labetalol ＋ sodium nitroprusside, n = 40）. Controlled bypotension was conducted for all patients after anesthesia in- duction. The hemodynamic change, surgery situtations, drug resistance and hypotension drug related adverse cardiac events were observed, the total doses of narcotic drugs and hypotension drugs were recorded, and the levels of lac- tate, blood glucose, and plasma cortisol in arterial blood were detected at several main time points. [ Results ] The heart rate, mean arterial pressure and central venous pressure were decreased more significantly in group D （P 〈 0.01）, and no rebound was occurred after hypotension drugs were withdrawn in group D （P 〈 0.01）. The amount of blood loss, fluid volume and the total doses of nitroprusside and propofol of group D were less than those of group L （P 〈 0.01, P 〈 0.05）, the urine volume of group D was more than that of group L （P 〈 0.05）, and the quality of thesurgical field was better in group D （P 〈 0.01）. The levels of blood glucose and plasma cortisol were increased signif- icantly in group L than those in group D （P 〈 0.01）. [Conclusions] Dexmedetomidine combined with nitroprusside for controlled hypotension in hip replacement surgery of elderly patients is more effective than labetalol combined with nitroprusside, as the former can suppress stress response more effectivly with fewer doses of narcotic drugs and blood loss. However, care must be taken to the incidences of hypotension drug related adverse cardiac events such as bradycardia and hypotension.

关 键 词：硝普钠 右美托咪定 拉贝洛尔 控制性降压 髋关节置换术 

分 类 号：R687.4[医药卫生—骨科学]