控制性降压在全麻下膝关节置换中的应用  

Controlled hypotension under general anesthesia for total knee arthroplasty

作　　者：刘克[1] 徐伟民[1] 林泉[1] 钟梦霞 王大龙[1] 张金龙 叶文学 LIU Ke;XU Wei-min;LIN Quan;ZHONG Meng-xia;WANG Da-long;ZHANG Jin-long;YE Wen-xue(Central Hospital of Shengli Oilfield,Dongying 257034,China)

机构地区：[1]胜利油田中心医院,山东东营257034

出　　处：《中国矫形外科杂志》2021年第16期1446-1450,共5页Orthopedic Journal of China

摘　　要：[目的]评价控制性降压在全麻下膝关节置换(total knee arthroplasty,TKA)中的早期临床结果。[方法]2019年1月—2020年12月行全麻下TKA患者120例,随机分为控制性降压组和常规组,每组60例。控制性降压组使用右美托咪定联合七氟醚进行控制性降压,不使用止血带,常规组全程使用止血带。比较两组临床表现,术中血流动力学变化和实验室肾功检测指标。[结果]两组患者均顺利完成手术,控制性降压组不良反应发生率显著低于常规组(21.67%vs 48.33%,P<0.05)。控制性降压组术中输液量[(750.83±100.63)ml vs(1006.67±103.93)ml,P<0.05]、出血量[(145.17±31.81)ml vs(246.33±49.95)ml,P<0.05]和术后24 h引流量[(213.33±25.29)ml vs(260.67±30.08)ml,P<0.05]均显著少于常规组(P<0.05)。两组患者手术时间、术中尿量组间比较差异无统计学意义(P>0.05)。血流动力学方面,两组患者在麻醉前、诱导10 min时MAP、HR均无明显差异(P<0.05),控制降压5 min和10 min时,控制性降压组的MAP、HR显著低于常规组(P<0.05),停止降压10 min两组间MAP差异无统计学意义,但控制性降压组的HR仍然明显低于常规组(P<0.05)。检测方面,术后1、24h控制性降压组的Cr、BUN、Cys-C水平显著低于常规组,而GFR显著高于常规组(P<0.05)。[结论]右美托咪定联合七氟醚在全麻下TKA术中控制性降压的应用效果良好,对肾脏有一定保护作用。[Objective] To evaluate the early clinical results of controlled hypotension under general anesthesia for total knee arthroplasty(TKA). [Methods] From January 2019 to December 2020, a total of 120 patients who were undergoing TKA under general anesthesia were randomly divided into the controlled hypotension group and routine group, with 60 cases in each group. The patients in the controlled blood pressure group were given dexmedetomidine combined with sevoflurane to control blood pressure with no tourniquet used,while those in the routine group receiving TKA underwent routine general anesthesia without controlled hypotension and with tourniquets used. The patients in the two groups were compared regarding to the clinical presentation, intraoperative hemodynamic changes and laboratory tests of renal function. [Results] The patients in both groups had TKA performed successfully. The controlled hypotension group proved significantly superior to the routine group regarding to adverse reactions(21.67% vs 48.33%, P<0.05). In addition, the controlled hypotension group was significantly better than the routine group in intraoperative infusion volume [(750.83±100.63) ml vs(1 006.67±103.93) ml, P<0.05], blood loss [(145.17±31.81) ml vs(246.33±49.95) ml, P<0.05], and 24 h postoperative drainage volume [(213.33±25.29) ml vs(260.67±30.08) ml, P<0.05], although there were no statistically significant differences between the two groups in operation time and intraoperative urine output(P>0.05). In terms of hemodynamics, there was no significant difference in MAP and HR between the two groups before anesthesia and at 10 minutes after induction(P<0.05), whereas the controlled hypotensive group got significantly lower MAP and HR at 5 and 10 minutes after controlled hypotension(P<0.05). There was no a statistically significant difference in MAP between the two groups after stopping blood pressure control for 10 minutes, but the controlled hypotension group remained significantly lower HR than that the routine group(P<0.05). In

关 键 词：全膝关节置换术 全身麻醉 控制性降压 

分 类 号：R687.4[医药卫生—骨科学]