右美托咪定联合尼卡地平用于骨科手术的控制性降压

Dexmedetomidine combined with nicardipine for controlled anti-hypertensive therapy in orthopedic surgery

目的探讨右美托咪定联合尼卡地平用于骨科手术控制性降压的效果。方法收集2011年1月至2012年6月本院收治的拟在全身麻醉下行全髋关节置换术、股骨交锁髓内钉固定术的患者90例，美国麻醉医师协会（ASA）分级I-Ⅱ级，采用随机数字表法将患者分为尼卡地平组（N组，n=30）、右美托咪定＋尼卡地平组（DN组，n=30）和对照组（c组，n=30）。DN组患者麻醉诱导前10min静脉注射右美托咪定，负荷剂量1μg／kg，随后以0．5μg·kg-1·h-的速率持续输注至手术结束前30min；N组和C组患者给予等量生理盐水相同速率输注。N组和DN组患者在手术开始时以2．5μg．kg-1．min-1的速率静脉输注尼卡地平，并调整尼卡地平剂量维持患者平均动脉压（MAP）在60～65mmHg（1mmHg=0．133kPa），缝合伤口时停用。记录3组患者术中异丙酚、芬太尼和尼卡地平用量，术中出血量、输液量和输血量、手术时间、清醒时间及拔管时间。结果与C组比较，N组和DN组患者术中出血量、输液量、输血量均明显减少（均P〈0．05），而N组和DN组差异无统计学意义（均P〉0．05）。与DN组比较，N组患者术中异丙酚、芬太尼、尼卡地平用量增加，清醒时间及拔管时间延长（均P〈0．05）。与DN组比较，C组患者异丙酚、芬太尼用量增加（均P〈0．05）。与C组比较，N组患者清醒时间及拔管时间延长（均P〈0．05）。结论右美托咪定联合尼卡地平用于骨科手术控制性降压时，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，减少术中出血。

Objective To evaluate the efficacy of dexmedetomidine combined with nicardipine for controlled anti-hypertensive therapy in orthopedic surgery. Methods Ninety patients with ASA I or Ⅱ grading scheduled for hip joint replacement and femoral lock nailing internal fixation surgery under general anesthesia between January 2011 and June 2012 were randomly allocated to nicardipine group （group N, n=30） , dexmedetomidine plus nicardipine group （group DN, n=30） and control group （group C, n= 30）, respectively. Patients in group DN received a loading dose of dexmedetomidine （ 1 p,g/kg） intravenous injection for 10 min before induction, followed by maintenance infusion at the dose of 0.5 μg. kg-l. h-I till 30 min before cessation of surgery. Patients in groups C and N received normal saline intravenous injection at an identical rate throughout the course. Nicardipine was administered in groups N and DN, with the dose of nicardipine 2.5 p,g. kg-l. min-I at the beginning of operation, and adjusted by maintaining the mean arterial pressure （MAP） between 60 and 65 mm Hg （ 1 mm Hg=0.133 kPa） before suturing of the wound. The dose of propofol, fentanyl and nicardipine, the volume of hemorrhage, transfusion and blood transfusion, the duration of surgery and recovery of consciousness and extubation were recorded. Results Compared with group C, the volume of hemorrhage, transfusion and blood transfusion were significantly lower in groups Nand DN with significant difference （all P〈0.05）, while there is no difference between group N and group DN （all P〉0.05）. Compared with group DN, group N required an increased dose of propofol, fentanyl and nicardipine, and was characterized by a prolonged duration to recovery of consciousness and extubation （all P〈0.05）. Compared with group DN, a higher dose of propofol and fentanyl was administered in group C （all P〈0.05）. Group N was characterized by a prolonged duration to consciousness and extubation as compared with group C （all P〈0.05）. Conclusion The combination of dexmedetomidine and nicardipine during orthopedic surgery is associated with reduced dose of nicardipine and anesthetic drugs, shorter time to recovery of consciousness, improved outcomes of controlled anti-hypertensive therapy and reduced volume of hemorrhage.