硝普钠控制性降压辅以右美托咪定在脊柱手术中的运用

Application of Sodium Nitroprusside Combined with Dexmedetomidine for Controlled Hypotension in Spinal Operation

目的本研究旨在探讨右美托咪定作为辅助用药,在硝普钠控制性降压中的应用,为临床提供理论和实验依据。方法选取拟行手术治疗的胸椎及腰椎骨折患者120例,ASAI-II级,随机分为2组(每组60例):A组使用硝普钠控制性降压组;B组使用右美托咪定配合硝普钠控制性降压组。两组患者之间性别、年龄等一般资料差异无统计学意义。术中观察两组患者术前(T0),降压开始5min(T1),停止降压后5min(T2),拔管后1min(T3)不同时间点的HR,MAP,同时记录降压时间及术毕患者清醒拔管时间。结果 B组患者在降压开始T1,T2,T3的HR均明显低于A组,差异有统计学意义(P<0.05或P<0.01)。而B组的MAP在T0和T1均与A组的差异没有统计学意义,而在T2和T3时间点,明显低于A组,差异有统计学意义(P<0.05或P<0.01)。两组患者的降压时间和术后苏醒拔管时间相比,差异没有统计学意义(P>0.05)。而联合使用右美托咪定组硝普钠的用量明显降低。由34.62±6.39 mg下降到27.58±5.86 mg,下降约20.3%,差异具有统计学意义(P<0.05)。结论术中辅以右美托咪定,不仅可以维持手术要求的MAP,并且可以维持合适的心率并减少术中硝普钠的用量。对患者的苏醒和恢复没有明显的影响。因此,右美托咪定可以用于控制性降压的辅助用药,在与硝普钠合用时,可以降低其不良反应。

Objective To evaluate the application of dexmedetomidine （ DEX） in controlled hypotension with sodium nitro-prusside （ SNP） and take the basis for clinical application. Methods 120 patients who underwent spinal operation with ASA Ⅰ-Ⅱwere divided 2 groups （ n=60 each group） randomly：A, SNP group;B, SNP and DEX group. There was no significant difference between two groups in common information such as sex and age. HR and MAP were recorded in before operation （ T0 ） , controlled hypotension for 5 min （T1）, stopped hypotension for 5 min （T2） and after extubation for 1 min （T3） each group. The duration of hypotension and extubation after operation was also recorded. Results HR in group B was slower than that in group A in T1, T2, T3 （P〈0. 05 or P〈0. 01）. MAP in group B was lower in T2 and T3. there was no significant difference between two groups in duration of hypotension and extubation after operation. The dose of SNP in group B was decreased from 34. 62 ± 6. 39 mg to 27. 58 ± 5. 86 mg （P〈0. 05）. Conclusion It may maintain reasonable MAP and HR, and decreased the dose of SNP that DEX was applied in control hypotension with SNP. DEX is a good candidate for ancillary drug in control hypotension with reducing the adverse effect of SNP.