右美托咪定复合尼卡地平用于骨科手术患者控制性降压的效果

Efficacy of dexmedetomidine combined with nicardipine for controlled hypoteusion in patients undergoing orthopedic surgery

目的探讨右美托咪定复合尼卡地平用于骨科手术患者控制性降压的效果。方法拟在全身麻醉下行全髋关节置换术或股骨交锁髓内钉固定术的患者60例，年龄32～64岁，体重45～76kg，ASA分级I或Ⅱ级，采用随机数字表法，将患者随机分为2组（n=30）：尼卡地平组（N组）和右美托咪定＋尼卡地平组（DN组）。DN组麻醉诱导前10min静脉注射右美托咪定负荷剂量1μg／kg，继之以0．5μg·kg^-1·h^-1的速率静脉输注至手术结束前30min，N组给予等量生理盐水。术中维持BIS值40～49。手术开始时以2．5μg·kg^-1·min^-1的速率静脉输注尼卡地平，使MAP降至60～65mmHg，之后调整输注速率维持MAP在此水平，缝合伤口时停用尼卡地平。记录术中麻醉药和尼卡地平用量、出血量、输液量和异体输血情况，记录手术时间、清醒时间及拔管时间。结果两组术中均未输注异体血。与N组比较，DN组术中麻醉药用量和尼卡地平用量降低，清醒时间及拔管时间缩短（P〈0．05），术中输液量、出血量比较差异无统计学意义（P〉0．05）。结论右美托咪定复合尼卡地平用于骨科手术患者控制性降压时，可减少尼卡地平和术中麻醉药用量，缩短患者麻醉恢复时间，优化尼卡地平控制性降压的效果。

Objective To evaluate the efficacy of dexmedetomidine combined with nicardipine for con- trolled hypotension in patients undergoing orthopedic surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 32-64 yr, weighing 45-76 kg, scheduled for orthopedic surgery under general anesthesia, were randomly allocated into 2 groups （n = 30 each）： nicardipine group （group N） and dexmedetomidine ＋ nicardipine group （group DN）. A loading dose of dexmedetomidine 1 μg/kg was injected intravenously 10 min before induction of anesthesia, followed by infusion at 0.5μg · kg^- 1· h ^- 1 until 30 min before the end of operation in group DN. While the equal volume of normal saline was given in group N. BIS value was maintained at 40-49 during operation. Controlled hypotension was performed with iv infusion of nicardipine at a rate of 2.5 μg · kg^-1· min^- 1 , MAP was reduced to 60-65 mm Hg, then the infusion rate was adjusted to maintain MAP at this level, and nicardipine infusion was stopped while closing the skin. The amount of anesthetics and nicardipine consumed, blood loss, volume of fluid infused, and allogeneic blood transfusion during operation and the operation time, emergence time and extubation time were recorded. Results No patient received allogeneic blood transfusion in both groups. Compared with group N, the amount of anesthetics and nicardipine consumed was significantly decreased, the emergence time and extubation time were significantly shortened （P 〈 0.05）, and no significant change in the volume of fluid infused and blood loss was found in group DN （ P 〉 0.05）. Conclusion Dexmedetomidine combined with nicardipine can reduce the requirements for nicardipine and anesthetics during operation, shorten the time for recovery from anesthesia and ira-prove the efficacy of nicardipine for controlled hypotension when used tbr controlled hypotension in patients underg- oing orthopedic surgery.