右美托咪定抑制老年高血压患者下肢手术止血带相关高血压的临床研究  

Clinical effects of dexmedetomidine in inhibiting tourniquet-induced hypertension in elderly patients with hypertension undergoing lower limb surgery

作　　者：刘秀叶 郭琼梅[1] 王莉[1] 周长浩[1] 张泽[1] LIU Xiuye;GUO Qiongmei;WANG Li(Department of Anesthesiology,The First Hospital of Hebei Medical University,Hebei,Shijiazhuang 050031,China)

机构地区：[1]河北医科大学第一医院麻醉科,石家庄市050031

出　　处：《河北医药》2021年第21期3258-3261,共4页Hebei Medical Journal

基　　金：河北省卫生和健康委员会青年科技课题(编号:20201157)。

摘　　要：目的观察右美托咪定抑制老年高血压患者下肢手术止血带相关性高血压的临床效果。方法选择择期全麻下行骨科下肢手术需用止血带的老年患者80例,其中高血压40例,分为高血压右美托咪定组(D1,n=20),非高血压右美托咪定组(D2,n=20),高血压非右美托咪定组(C1,n=20)和非高血压非右美托咪定组(C2,n=20)。D1组和D2组于麻醉诱导后给予负荷量右美托咪定1μg/kg(给药时间15 min),随后以0.4μg·kg^(-1)·h^(-1)的速率维持至手术结束前30 min,C1组和C2组以同样的方法给予等容量0.9%氯化钠溶液。观察麻醉前(T0)、上止血带即刻(T1)、上止血带后10 min(T2)、上止血带后30 min(T3)、上止血带后60 min(T4)和松止血带后1 min(T5)6个时间点的SBP、DBP、HR等血流动力学指标,并抽取桡动脉血测定血浆中肾上腺素(E)、去甲肾上腺素(NE)水平。使用止血带后收缩压或舒张压较基础值升高>30%定义为止血带相关性高血压反应,记录此时SBP、DBP值,比较4组止血带相关性高血压发生率。结果高血压D1组、C1组T2~T5时SBP、DBP、HR分别高于非高血压D2组、C2组(P<0.05);D1组、D2组T2~T4时SBP、DBP分别低于C1组、C2组(P<0.05);D1组、D2组T2~T5时HR分别低于C1组、C2组(P<0.05);D1组、C1组T2~T5时E、NE水平分别高于D2组、C2组(P<0.05),D1组、D2组T2~T5时E、NE水平分别低于C1组、C2组(P<0.05);D1、D2组止血带相关性高血压发生率分别低于C1、C2组(P<0.05)。结论右美托咪定可抑制老年高血压患者下肢手术止血带相关性高血压反应,抑制交感神经兴奋,维持术中血流动力学平稳,降低围手术期不良事件发生。Objective To investigate the clinical effects of dexmedetomidine in inhibiting tourniquet-induced hypertension in elderly patients with hypertension undergoing lower limb surgery.Methods A total of 80 elderly patients who received orthopedic lower limb surgery with tourniquets under general anesthesia,including 40 cases of hypertension,who were divided into hypertensive dexmedetomidine group(D1,n=20),non-hypertensive dexmedetomidine group(D2,n=20),hypertensive non-dexmedetomidine group(C1,n=20)and non-hypertensive non-dexmedetomidine group(C2,n=20).The patients in D1 and D2 groups were given 1μg/kg of dexmedetomidine before anesthesia induction(administration time 15min),and then maintained at a rate of 0.4μg·kg^(-1)·h^(-1) until 30min before the end of surgery.And the patients in C1 and C2 groups were given equal volume of normal saline.The hemodynamic indexes including SBP,DBP and HR were observed and recorded at 6 time points before anesthesia(T0),immediately after tourniquet(T1),10min(T2),30min(T3),60min after tourniquet inflation(T4)and 1min after tourniquet loosening(T5).Moreover the plasma levels of adrenaline(E)and norepinephrine(NE)were detected.Tourniquet-induced hypertension was defined as a 30%increase from baseline in either the systolic or diastolic blood pressure after applying tourniquet,and SBP and DBP values were recorded at this time to compare the incidence of tourniquet related hypertension incidence among groups.Results The levels of SBP,DBP and HR at T2-T5 in D1 group and C1 group were significantly higher than those in D2 group and C2 group(P<0.05),and the levels of SBP and DBP at T2-T4 in D1 group and D2 group were significantly lower than those in C1 group and C2 group(P<0.05).In addition the HR levels in D1 group and D2 group were significantly lower than those in C1 group and C2 group(P<0.05).The E and NE levels at T2-T5 in D1 group and C1 group were significantly higher than those in D2 group and C2 group(P<0.05),which in D1 group and D2 group were significantly lower than those i

关 键 词：右美托咪定 老年高血压 止血带 止血带相关性高血压 交感神经反应 

分 类 号：R971.2[医药卫生—药品]