瑞芬太尼联合右美托咪定用于老年患者骨科手术中的临床研究  

Clinical trial of remifentanil combined with dexmedetomidine in orthopedic surgery for the elderly patients

作　　者：张志敏[1] 李永乐[1] 牛小龙[2] 武广义[1] 王颖[1] 甘璐 ZHANG Zhi-min;LI Yong-le;NIU Xiao-long;WU Guang-yi;WANG Ying;GAN Lu(Department of Anesthesiology,Affiliated Hospital of Hebei University,Baoding 071000,China;Department of Anatomy,School of Medicine,Hebei University Health Science Center,Baoding 071000,China)

机构地区：[1]河北大学附属医院麻醉科,河北保定071000 [2]河北大学医学部解剖教研室,河北保定071000

出　　处：《中国临床药理学杂志》2024年第2期190-194,共5页The Chinese Journal of Clinical Pharmacology

摘　　要：目的探究瑞芬太尼、右美托咪定控制性降压对老年骨科手术患者凝血功能、脑氧代谢和氨基酸类神经递质水平的影响。方法入选行下肢骨科手术的老年患者为研究对象,根据麻醉药物不同分为A组(给予右美托咪定降压)、B组(给予瑞芬太尼降压)、C组(给予瑞芬太尼联合右美托咪定降压)。比较3组患者收缩压(SBP)、舒张压(DBP)、心率(HR),脑氧代谢[颈内动脉血氧含量(CaO_(2))、颈静脉球部血氧饱和度(SjvO_(2))、颈内静脉血氧含量(CjvO_(2))]、凝血功能[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、血浆纤维蛋白原(FIB)]、氨基酸类神经递质[谷氨酸(Glu)、天冬氨酸(Asp)、γ-氨基丁酸(GABA)],并记录试验期间药物不良反应发生情况。结果麻醉后12 h,A组、B组和C组的APTT分别为(17.26±2.77)、(17.37±2.92)和(31.11±4.74)s,GABA分别为(18.74±2.71)、(19.22±2.60)和(23.37±2.59)mmol·L^(-1);停药后3 min,A组、B组和C组的CaO_(2)分别为(139.31±9.03)、(140.90±8.70)和(131.75±10.11)mL·L^(-1),SjvO_(2)分别为(63.59±2.23)%、(63.40±2.44)%和(68.82±3.36)%;C组的上述指标与A组、B组比较,差异均有统计学意义(均P<0.05)。A组、B组和C组的药物不良反应发生率分别为12.82%、27.50%和7.32%,C组药物不良反应发生率低于A组和B组(均P<0.05)。结论瑞芬太尼联合右美托咪定控制性降压应用于老年骨科手术,有较好的血压控制效果,可改善患者术后凝血功能,维持脑氧代谢平衡,减少认知功能损伤以及麻醉不良反应的发生。Objective To investigate the effects of remifentanil and dexmedetomidine controlled hypotension on coagulation function,cerebral oxygen metabolism and amino acid neurotransmitter levels in elderly patients undergoing orthopedic surgery.Methods The elderly patients who underwent lower extremity orthopedic surgery were divided into group A(given dexmedetomidine for hypotension),group B(given remifentanil for hypotension)and group C(given remifentanil combined with dexmedetomidine for hypotension)according to different anesthetic drugs.Systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)were compared among the 3 groups.Cerebral oxygen metabolism[arterial oxygen content,(CaO_(2)),oxygen saturation of int ernal jugular vein(SjvO_(2)),oxygen content of internal jugular vein(CjvO_(2))],coagulation function[activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),plasma fibrinogen(FIB)],amino acid neurotransmitters[glutamic acid(Glu),aspartate(Asp),gamma-aminobutyric acid(GABA)]were compared,and the occurrence of adverse drug reactions during the trial were compared.Results At 12 h after anesthesia,the APTT of group A,group B and group C were(17.26±2.77),(17.37±2.92)and(31.11±4.74)s,respectively.GABA were(18.74±2.71),(19.22±2.60)and(23.37±2.59)mmol·L^(-1),respectively.3 min after withdrawal,CaO_(2) in group A,group B and group C were(139.31±9.03),(140.90±8.70)and(131.75±10.11)mL·L^(-1),respectively;SjvO_(2) were(63.59±2.23)%,(63.40±2.44)%and(68.82±3.36)%,respectively.The above indexes of group C were compared with those of group A and group B,and the differences were statistically significant(all P<0.05).The incidence of adverse drug reactions in group A,B and C were 12.82%,27.50%and 7.32%,respectively.The incidence of adverse drug reactions in group C were lower than that in group A and group B(P<0.05).Conclusion Remifentanil combined with dexmedetomidine for controlled hypotension in elderly orthopedic surgery has better blood pressure control effect,can i

关 键 词：瑞芬太尼 右美托咪定 膝关节置换术 老年 凝血功能 脑氧代谢 氨基酸类神经递质 

分 类 号：R97[医药卫生—药品]