右美托咪啶预处理在老年高血压患者髋关节置换术中的应用研究  

Study of application of dexmedetomidine pretreatment in hip arthroplasty in the el­derly patients with hypertension

作　　者：孙婷辉 上官云芳 段思源[1] SUN Tinghui;SHANGGUAN Yunfang;DUAN Siyuan(Department of Anesthesiology of Shanghai Integrated Traditional Chinese and Western Medicine Hospital,Shanghai 200082,China)

机构地区：[1]上海市中西医结合医院麻醉科,上海200082

出　　处：《上海医药》2023年第18期20-23,62,共5页Shanghai Medical & Pharmaceutical Journal

摘　　要：目的:探讨右美托咪啶对比咪达唑仑预处理对全麻下行髋关节置换术老年高血压患者血流动力学的影响。方法:选取2019年1月至2022年1月在上海市中西医结合医院行髋关节置换术的老年高血压患者66例,随机分为右美托咪啶组(D组)和咪达唑仑组(M组),每组33例。麻醉诱导前,D组静脉滴注右美托咪啶0.5μg/kg,M组静脉推注咪达唑仑0.025 mg/kg预处理。分别于预处理前(T0)、预处理5 min(T1)、预处理10 min(T2)、麻醉诱导后即刻(T3)、气管插管后即刻(T4)、手术开始时(T5)、手术开始后15 min(T6)、手术开始后30 min(T7)、气管拔管后1 min(T8)及气管拔管后5 min(T9)时观测血流动力学参数(收缩压,舒张压,平均动脉压,心率)、麻醉药物丙泊酚的用量及麻醉相关不良事件发生情况。结果:T2、T3、T4、T8和T9时的收缩压、舒张压及平均动脉压对比T0时,D组变化小于M组(P<0.05)。麻醉药物丙泊酚用量D组需求量更少(P<0.05),但D组的不良反应口干和心率下降发生率高于M组(P<0.05)。结论:相比咪达唑仑,在老年高血压患者行髋关节置换术前用右美托咪啶预处理对患者血流动力学影响小,能使患者更平稳的度过围手术期。Objective:To investigate the effect of dexmedetomidine versus midazolam in the pretreatment on the hemodynamics of hip arthroplasty in the elderly patients with hypertension under general anesthesia.Methods:A total of 66 elderly hypertensive patients who underwent hip arthroplasty in Shanghai Integrated Traditional Chinese and Western Medicine(TCM)Hospital from January 2019 to January 2022 were selected,and randomly divided into a dexmedetomidine group(group D),and a midazolam group(group M)with 33 cases each.Before anesthesia induction,the group D was given dexmedetomidine 0.5μg/kg intravenously,the group M was given midazolam 0.025 mg/kg for pretreatment.The hemodynamic parameters(SBP,DBP,MBP and HR),the dosage of propofol and the incidence of anesthesia related adverse events were observed at the following time points:pretreatment(T0),pretreatment for 5 min(T1),pretreatment for 10 min(T2),immediately after anesthesia induction(T3),immediately after tracheal intubation(T4),at the start of surgery(T5),15 min after surgery(T6),30 min after surgery(T7),1 min after tracheal extubation(T8)and 5 min after tracheal extubation(T9).Results:The changes of SBP,DBP and MBP at T2,T3,T4,T8 and T9 were smaller in group D than those in group M were compared with T0(P<0.05),and the change in the group D was smaller than that in the group M.The amount of propofol in the group D was less(P<0.05),but the adverse reaction of dry mouth and heart rate decreased in the group D were higher than those in the group M(P<0.05).Conclusion:Compared with midazolam,dexmedetomidine pretreatment before hip arthroplasty in the elderly hypertensive patients has less effect on hemodynamics,which enables patients to pass the perioperative period more smoothly.

关 键 词：髋关节置换术 老年高血压 右美托咪啶 预处理 血流动力学 

分 类 号：R687.4[医药卫生—骨科学]