盐酸右美托咪定用于脊柱手术控制性降压的研究

Study on deliberate hypotension of dexmedetomidine hydrochloride in patients undergoing spinal surgery

目的研究盐酸右美托咪定用于控制性降压患者的安全性、可行性和对患者脑氧代谢、术后认知功能的影响。方法选择全麻下行脊柱手术的患者60例，随机分为D组N组，每组30例。两组麻醉方法相同，D组予盐酸右美托咪负荷剂量0．5μg／kg静注（5min）后以0．2～0．7μg／（kg·h）速度泵注维持；N组以硝酸甘油2μg／kg缓慢静注，以3～6pg／（kg·min）维持，目标使MAP较术前基础值下降30％，降压时间为70分钟。监测并记录各组T0-T6时点的MAP、HR、ECG、BIS、SEVO％。在T0、T6时刻血气分析计算CaO2、CjvO2、CERO2。记录术前、术后MMSE评分。结果D组在T2-T5期间HR波动于（55．7±6．4）至（65．73．4±5．2）bpm，与对应时间点N组的（76．5±7．7）至（85．5±8．2）bpm明显下降（P〈0．05），D组MAP在T．、R分别为（85．8±5．7）、（80．5±7．9）mmHg，与相应N组的（77．4±6．7）、（91．3±8．2）mmHg比较差异有显著性（P〈0．05）；两组患者T0、T6时点CERO2及MMSE评分差异无显著性（P〉0．05）。结论盐酸右美托咪定控制性降压是安全可行的；对脑氧代谢及术后认知功能无明显影响。

Objective To investigate the safety and feasibility of deliberate hypotension with dexmedetomidine hydrochloride ,as well as the effects on cerebral oxygen metabolism and postoperative cognitive function. Methods Sixty patients who underwent posterior lumbar interbody fusion were randomly divided into group D and group N,30 in each group. Both groups were anesthetized with same methods. In group D, intravenous administration of dexmedetomidine hydrochloride 0.5 μ g/kg followed by infusion of 0.2-0.7 μ g/（ kg· h ）for deliberate hypotension ,and the patients of group N received nitroglycerin 2 μg/kg followed by 3-6 μ g/（ kg· min ）. The target of deliberate hypotension was in order to reduce the MAP to 30%, which was maintained for 70 minutes. Record MAP,HR,ECG,BIS,SEVO%,and arterial blood samples and jugular blood samples were taken synchronously for measuring blood gas, MMSE were recorded before and after operation .Results Compared with N group,heart rate of D group decreased significantly from time T2 to T5 （P〈0.05）, the mean arterial pressure in group D was increased at T5 and increased at T6（P〈0.05）. The level of CERO2 and MMSE showed no significant change（P〉0.05）. Conclusions The patients of deliberate hypotension with dexmedetomidine hydrochloride was safe and feasible. It had no effect on the cerebral oxygen metabolism and postoperative cognitive function.