發(fā)布時間：2018-05-06 19:14

  本文選題：髖關(guān)節(jié)置換術(shù) + 氫化潑尼松��； 參考：《山東醫(yī)藥》2017年37期

【摘要】：目的探討預防性使用氫化潑尼松與甲氧明對老年患者髖關(guān)節(jié)置換術(shù)中血流動力學的影響。方法選擇行髖關(guān)節(jié)置換術(shù)老年患者60例,采用隨機數(shù)字表法分為三組C組、MI組和MP組各20例。三組均給予全麻,于骨水泥灌注前均給予氫化潑尼松0.5 mg/kg靜滴。骨水泥灌注前1 min,C組、MI組分別給予生理鹽水1 m L、甲氧明1mg靜注;MP組給予甲氧明負荷劑量100μg經(jīng)微量泵靜脈輸注,之后以1~2μg/(kg·min)持續(xù)泵注10 min。記錄三組麻醉前5 min(T0)、骨水泥灌注前1 min(T_1)及骨水泥灌注后1 min(T_2)、3 min(T_3)、5 min(T_4)、10 min(T_5)、15 min(T_6)SBP、DBP、平均動脈壓(MAP)、HR,并測定動脈血乳酸(Lac)。記錄三組術(shù)中發(fā)生的低血壓、心動過緩、心動過速及術(shù)后惡心嘔吐、圍術(shù)期心血管事件。結(jié)果與T_1時比較,C組T_2、T_3、T_4時SBP、DBP、MAP降低,T_3、T_4、T_5時HR升高(P均0.05);MI組T_2時HR,T_4時SBP、DBP、MAP降低(P均0.05);MP組T_2、T_3、T_4、T_5、T_6時各時點SBP、DBP、MAP、HR比較,P均0.05。與T_1時比較,C組T_4、T_5時Lac水平升高(P均0.05);MI組T_5時Lac水平升高(P均0.05);MP組T_4、T_5、T_6各時點Lac水平比較,P均0.05。C組低血壓發(fā)生率高于MI組、MP組(P均0.05),MI組心動過緩發(fā)生率高于MP組(P0.05),三組心動過速、圍術(shù)期心血管事件發(fā)生率比較差異無統(tǒng)計學意義(P均0.05)。結(jié)論骨水泥灌注前預防性應用氫化潑尼松與甲氧明可有效維持老年患者人工髖關(guān)節(jié)置換術(shù)中血流動力學的穩(wěn)定;且甲氧明持續(xù)靜脈泵注變速給藥較單次靜脈注射給藥對HR的影響更小。
[Abstract]:Objective to investigate the effect of prophylactic use of prednisone and methoxifen on hemodynamics during hip arthroplasty in elderly patients. Methods Sixty elderly patients undergoing hip arthroplasty were randomly divided into three groups: group C (n = 20) and group MP (n = 20). All the three groups were given general anesthesia and hydroprednisone 0.5 mg/kg intravenous drip before bone cement perfusion. The MI group was given 1 mL normal saline one minute before the bone cement perfusion, and 100 渭 g methoxifen loading dose was injected intravenously through a micropump in the MP group with methoxifen 1mg, and then continued to be pumped for 10 minutes with 1 渭 min 2 渭 g/(kg min. Five minutes before anesthesia and one minute before bone cement perfusion were recorded in the three groups, and 1 minute after the infusion of bone cement, 1 minute after the infusion of bone cement, the two groups were recorded, and 1 min after the infusion of bone cement, 3 minutes after the infusion of bone cement, 3 mins, 5 mins, 15 mins, T6, SBP, DBP, HRs of arterial blood lactic acid, were measured. The incidence of hypotension, bradycardia, tachycardia, postoperative nausea and vomiting, perioperative cardiovascular events in the three groups were recorded. Results compared with T _ 1, SBPDBPU map decreased at T _ 2T _ 3 / T _ 4 in C group and increased at T _ (3) T _ (4) T _ (5) / T _ (5) T _ (5) T _ (all) T _ (2) T _ (map) in T _ (2) T _ (3) T _ (3) T _ (3) T _ (3) T _ (4) T _ 4 / T _ (5) T _ 6 in T _ 2T _ 3 / T _ 4 / T _ (5) in T _ 6 compared with 0.05 in T _ 2T _ (3) T _ (3) T _ (4) T _ 4 / T _ (5) / T _ (6). The level of Lac in group C was higher than that in group T _ 4 and T _ 5. The level of Lac in group T _ 5 was higher than that in group T _ 5. The Lac level in group T _ (4) and T _ (5) T _ (6) was higher than that in group (P = 0.05), and the incidence of bradycardia in group P was higher than that in group MP (P = 0.05), and the incidence of bradycardia in group C was higher than that in group MP (P < 0.05), and the incidence of bradycardia in group T _ (0.05) was higher than that in group M (P < 0.05). There was no significant difference in the incidence of cardiovascular events in perioperative period (P < 0.05). Conclusion the prophylactic application of prednisone and methoxifen before bone cement perfusion can effectively maintain the hemodynamic stability in the elderly patients undergoing hip replacement. The effect of continuous intravenous infusion of methoxifen on HR was less than that of single intravenous injection.
【作者單位】： 武漢大學中南醫(yī)院;十堰市太和醫(yī)院;
【分類號】：R687.4

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