本文選題：右美托咪定 + 七氟烷　； 參考：《廣東醫(yī)學(xué)》2015年10期

【摘要】：目的觀察右美托咪定(Dex)復(fù)合七氟烷在脊柱后路手術(shù)中控制性低血壓的效果,比較Dex和硝普鈉對患者腎素-血管緊張素-醛固酮系統(tǒng)(RAAS)的影響。方法選擇術(shù)中需行控制性低血壓的脊柱后路手術(shù)患者60例(ASAⅠ或Ⅱ級),氣管插管后,控制呼氣末七氟烷濃度為(2.0±0.5)%。按降壓方法將患者分為N組和D組,每組30例,均使平均動脈壓(MAP)降低至基礎(chǔ)值的60%~70%(目標(biāo)血壓)。N組:患者放置俯臥位后開始持續(xù)避光泵注0.1%硝普鈉,以0.5μg/(kg·h)速度開始,根據(jù)MAP調(diào)整劑量。D組:患者放置俯臥位后開始泵注負(fù)荷量Dex 1.0μg/kg(稀釋至20 m L以120 m L/h速度10 min泵注完畢),繼以0.2~0.8μg/(kg·h)(濃度4μg/m L)泵注維持,根據(jù)MAP調(diào)整速度。記錄麻醉誘導(dǎo)前(T0)、控制性低血壓前即刻(T1)、控制性低血壓后15min(T2)、控制性低血壓后30 min(T3)、控制性低血壓結(jié)束后20 min(T4)的心率(HR)、MAP、達(dá)目標(biāo)血壓時間、控制性低血壓持續(xù)時間、手術(shù)時間、出血量及尿量、術(shù)野質(zhì)量評分(SSFQ),同時測定血漿中腎素、血管緊張素Ⅱ、醛固酮含量。由同一術(shù)者在不知道控制性低血壓方式的情況下評估術(shù)野質(zhì)量。結(jié)果兩組患者年齡、體重、性別比、控制性低血壓持續(xù)時間、手術(shù)時間組間比較,差異無統(tǒng)計學(xué)意義(P0.05)。所有患者術(shù)中MAP均能維持在目標(biāo)范圍。N組T2~T4的HR較T0和T1增加(P0.05);D組T2~T4的HR較T0和T1減慢(P0.05),也較N組T2~T4的慢(P0.05);N組T4的MAP較T0高,也高于D組T4(P0.05);D組T4的MAP較T0無明顯變化,差異無統(tǒng)計學(xué)意義(P0.05)。N組T2~T4腎素、血管緊張素Ⅱ、醛固酮含量高于T0和T1(P0.05),也高于D組相應(yīng)時點(diǎn)(P0.05)。D組T2~T4腎素、血管緊張素Ⅱ、醛固酮含量低于T0和T1(P0.05)。D組的出血量明顯較N組少(P0.05),尿量較N組多(P0.05),SSFQ低于N組(P0.05)。結(jié)論與硝普鈉相比,Dex復(fù)合七氟烷控制性低血壓過程平穩(wěn),無心動過速和高血壓反跳,能使手術(shù)視野更清晰,并在控制性低血壓期間抑制RAAS。
[Abstract]:Objective to observe the effect of dexmetomidine combined with sevoflurane on hypotension control in posterior spinal surgery and to compare the effects of Dex and sodium nitroprusside on renin-angiotensin-aldosterone system. Methods A total of 60 patients undergoing posterior spinal surgery with controlled hypotension were selected. After endotracheal intubation, the concentration of sevoflurane at the end of the breath was controlled to be 2.0 鹵0.5. The patients were divided into N group and D group according to the method of lowering blood pressure. Each group (30 cases) reduced the mean arterial pressure to 60% of the basic value. (target blood pressure. N group: after the patients were placed in prone position, 0.1% sodium nitroprusside was continuously injected with 0.1% sodium nitroprusside, starting with 0.5 渭 g/(kg / h). According to map adjusted dose. D group: the patients were placed in prone position and began to pump loading volume Dex 1.0 渭 g / kg (diluted to 20 mL at 120ml / h speed 10 min pump infusion), then maintained with 0.2c0. 8 渭 g/(kg hu (concentration 4 渭 g / m L) pump, adjusted the speed according to map. The heart rate (HR-MAPP) was recorded before anesthesia induction, immediately before controlled hypotension, 15 min after controlled hypotension, 30 min after controlled hypotension, 20 min after controlled hypotension. The levels of renin, angiotensin 鈪，

本文編號：2026767