右美托咪啶复合咪达唑仑及舒芬太尼对下肢手术止血带反应的抑制作用  

Dexmedetomidine combined with midazolam and sufentanil inhibit tourniquet response in lower extremity surgery

作　　者：后瑞淼 郭瑞娟[2] 洪方晓[2] HOU Rui-miao;GUO Rui-juan;HONG Fang-xiao(1.Department of Anesthesiology,Beijing Unicare EENT Hospital;Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]北京优联眼耳鼻喉医院麻醉科,北京100122 [2]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《临床和实验医学杂志》2018年第13期1388-1390,共3页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金(编号:81400909)

摘　　要：目的观察右美托咪啶复合咪达唑仑及舒芬太尼对下肢手术止血带反应的抑制作用。方法选择2017年9月至12月首都医科大学附属北京友谊医院收治的80例(年龄18～60岁,ASAⅠ～Ⅱ级)行下肢手术的骨科患者进行前瞻性研究。按照随机数字表法将患者分为4组:对照组(C组)、咪达唑仑+舒芬太尼组(M组),右美托咪啶组(D组)和右美托咪啶+咪达唑仑+舒芬太尼组(D+M组),每组各20例。C组常规行腰硬联合麻醉;M组在腰硬联合麻醉后给予咪达唑仑和舒芬太尼;D组在腰硬联合麻醉后给予右旋美托咪定;D+M组在腰硬联合麻醉后给予右旋美托咪定复合咪达唑仑、舒芬太尼。分别记录患者止血带充气前(T1),止血带充气后1 min(T2),止血带放气前(T3),止血带放气后1 min(T4)的各个时间点的平均动脉压(MAP)和心率(HR),观察不良反应发生情况。结果与T1时间点相比,4组患者在T2时间点的MAP和HR均无明显变化(P>0.05)。与T3时间点相比,在T4时间点,C组、M组和D组患者的MAP明显降低,HR明显增加(P<0.05),而D+M组的MAP和HR则无明显变化(P>0.05)。所有患者中C组(3例)和M组(2例)患者出现收缩压降低,D组(2例)患者出现心率降低,C组(4例),M组(1例),D组(3例)患者出现紧张不适。结论右美托咪啶复合咪达唑仑、舒芬太尼有助于维持骨科下肢手术使用止血带患者的血流动力学平稳。Objective To observe the effects of dexmedetomidine combined with midazolam and sufentanil on the tourniquet response in lower extremity surgery of orthopedic patients. Methods A prospective study was conducted on 80 orthopedic patients（ aging 18 ～ 60 years,ASAⅠ～Ⅱ） undergoing lower extremity surgery at the Beijing Friendship Hospital,Capital Medical University from September to December in 2017.The patients were divided into 4 groups by random number table,control group（ group C）,midazolam ＋ sufentanil group（ group M）,dexmedetomidine group（ group D） and dexmedetomidine combined with midazolam and sufentanil group（ group D ＋ M）. Combined spinal epidural anesthesia was routinely performed in group C. Midazolam and sufentanil were administered after combined spinal epidural anesthesia in group M.Dexmedetomidine was administered after combined spinal epidural anesthesia in group D. Dexmedetomidine combined with midazolam and sufentanil was administered after combined spinal epidural anesthesia in group D ＋ M. The mean arterial pressure（ MAP） and heart rate（ HR） of patients in four groups were recorded and compared at the following time points： before inflating tourniquet（ T1）,1 min after inflating tourniquet（ T2）,before deflating tourniquet（ T3）,1 min after deflating tourniquet（ T4）. Results Compared with T1 time point,the MAP and HR didn＇t changed at T2 time point in the four group C（ P〈0. 05）. Compared with T3 time point,the MAP was significantly decreased and HR was significantly increased at T4 time point in group C,group M and group D（ P〈0. 05）,while the MAP and HR didn＇t changed at T4 time point in the group D ＋ M（ P〈0. 05）. In all patients,systolic blood pressure decreased in group C（ 3 patients） and group M（ 2 patients）. Heart rate decreased in group D（ 2 patients）. The discomfort experience happened in group C（ 4 patients）,group M（ 1 patient） and group D（ 3 patients）.Conclusion Dexmedetomidine combined

关 键 词：止血带反应 右美托咪啶 舒芬太尼 咪达唑仑 血流动力学 

分 类 号：R614[医药卫生—麻醉学]