右美托咪定对青少年特发性脊柱侧凸矫形术中出血量的影响  

Effect of dexmedetomidine on intraoperative blood loss during orthopedic surgery for adolescent idi-opathic scoliosis

作　　者：贾锐[1] 李娜[2] 顾小萍[1] 马正良[1] 

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008 [2]东南大学医学院,南京市210009

出　　处：《中华麻醉学杂志》2017年第9期1048-1051,共4页Chinese Journal of Anesthesiology

摘　　要：选择2011年11月至2015年10月择期行后路脊柱矫形术的青少年特发性脊柱侧凸患者，年龄11～18岁，ASA分级I或Ⅱ级，共纳入834例患者，记录性别、年龄、身高、体重、Cobb角度、ASA分级、术中是否截骨、是否使用右美托咪定、手术节段数、手术时间、术中出血、输血及输液量，术后引流量及术后住院时间。按照是否使用右美托咪定分为使用右美托咪定组（D组）和未使用右美托咪定组（ND组）。将性别、年龄、BMI、Cobb角、ASA分级、手术节段数、手术时间、术中是否截骨以及是否使用右美托咪定作为自变量纳入多元逐步线性回归方程。多元逐步线性回归结果显示，术中截骨、手术节段数、手术时间和Cobb角与术中出血量呈正相关，使用右美托咪定和BMI与术中出血量呈负相关。与ND组比较，D组术中出血量、晶体液输注量、输血量以及术后引流量减少（P〈0．05）。倾向性匹配分析后，与D组比较，ND组术中出血量和术中晶体液用量减少（P〈0．05）。综上所述，术中使用右美托咪定有助于减少青少年特发性脊柱侧凸后路矫形术中出血量。American Society of Anesthesiologists （ASA） physical status I or 11 patients, aged 11-18 yr, scheduled for elective posterior orthopedic surgery for adoleseent idiopathic scoliosis from Novem- ber 2011 to October 2015 in our hospital, were selected, and a total of 834 patients were included in the study. Data including age, gender, body height, body weight, Cobb angles, ASA physical status, oste- otomy procedure, use of dexmedetomidine, the number of operation segments, duration of operation, intr- aoperative blood loss, volume of blood transfused and volume of fluid infused, volume of postoperative drainage and length of postoperative hospital stay were recorded. The patients were divided into dexmedeto- midine group （group D, n= 508） and non-dexmedetomidine group （ group ND, n = 326） depending on whether or not dexmedetomidine was used. Age, gender, body mass index, Cobb angles, ASA physical status, the number of operation segments, duration of operation, osteotomy procedure and use of dexme- detomidine were served as independent variables and analyzed using Stepwise multivariate linear regression. The results of Stepwise multivariate linear regression showed that osteotomy procedures, the number of oper- ation segments, duration of operation and Cobb angles were positively correlated with intraoperative blood loss, and use of dexmedetomidine and body mass index were negatively correlated with intraoperative blood loss. Compared with group ND, the intraoperative blood loss, volume of crystalloid solution infused, vol- ume of blood transfused and volume of postoperative drainage were significantly reduced in group D （P〈0. 05）. After a propensity score matching analysis, tlae mtraoperanve moon toss atJu vo,uJH~ ： solution infused were significantly reduced in group ND when compared with group D （P〈0. 05）. In con- clusion, intraoperative use of dexmedetomidine is helpful in reducing intraoperative blood loss during ortho- pedic surgery for adolescent idiopathic scoliosis.

关 键 词：右美托咪啶 脊柱侧凸 矫形外科手术 失血 手术 

分 类 号：R726.1[医药卫生—儿科]