右美托咪定辅助控制性降压联合高容量血液稀释在脊柱手术中的应用

Application of Dexmedetomidine-assisted Controlled Anti-hypertension Combined with High Capacity Hemodilution in Spinal Surgeries

目的：探讨右美托咪定辅助控制性降压联合高容量血液稀释在脊柱手术中应用的安全性、优越性和可靠性。方法：将进行全身麻醉下脊柱手术患者40例采用随机数字表法分为右美托咪定组（D组）和生理盐水组（S组）,各20例。两组均给予控制性降压联合高容量血液稀释的方法进行血液保护以及术中唤醒试验。其中,D组患者在麻醉诱导开始之前10min用微量泵在10min内输入1μg/kg右美托咪定,控制性降压期间以0.4~0.8μg/（kg·h）维持输注,唤醒试验和麻醉维持期间以0.2μg/（kg·h）输注至拔出气管导管;S组患者将右美托咪定换成生理盐水,泵注方法同D组。观察并记录患者泵注药品前（T0）、气管插管后1 min（T1）、麻醉诱导后10 min（T2）、麻醉诱导后30 min（T3）、唤醒时（T4）、控制性降压停止时（T5）、术毕时（T6）、拔出气管导管时（T7）的心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）,同时记录两组患者的唤醒试验时间、唤醒时出血量、硝酸甘油总量、异氟醚平均吸入浓度、瑞芬太尼总量、总出血量、术毕苏醒时间。统计两组患者术后发生苏醒延迟、寒战、烦躁的例数。结果：两组患者在T1、T7时的HR均较T0时加快,MAP、CVP均较T0时升高,且S组较D组明显（P〈0.05）;两组患者在T3时的HR、MAP较T0时明显降低（P〈0.05）;S组患者在T4时的MAP、CVP较T0时以及D组T4时升高,HR加快（P〈0.05）。D组患者的唤醒试验时间、术毕苏醒时间短于S组（P〈0.05）,唤醒时出血量、总出血量少于S组（P〈0.05）,硝酸甘油总量、异氟醚平均吸入浓度、瑞芬太尼总量小于S组（P〈0.05）;D组术后苏醒延迟、烦躁、寒战的发生率明显低于S组（P〈0.05）。结论：右美托咪定辅助控制性降压联合高容量血液稀释在脊柱手术中应用,使控制性降压更有效、稳定,能明显减少硝酸甘油、瑞芬太尼、丙泊酚、异氟醚的用量,是辅助控制性降压联合高容量血液稀释在脊柱手术中应用的安全、可靠的药物。

OBJECTIVE：To explore the safety,superiority and reliability of the application of dexmedetomidine-assisted controlled anti-hypertension combined with high capacity hemodilution in spinal surgeries. METHODS：40 patients with spinal surgeries under general anesthesia were randomly divided into dexmedetomidine group（group D）and normal saline（group S）with 20 cases in each group. Both groups were given controlled anti-hypertension combined with high capacity hemodilution to carry out blood conservation and intraoperative wakeup experiment. Group D was given 1 μg/kg dexmedetomidine within 10 min by micro pump 10 min before anesthesia induction;maintained with 0.4-0.8 μg/（kg·h）during controlled anti-hypertension;injected with dexmedetomidine 0.2 μg/（kg·h） during wakeup experiment and anesthesia maintenance period until tracheal catheter was extracted.Group S was given normal saline instead,and the usage was same as group D. Heart rate（HR）,mean arterial pressure（MAP）and central venous pressure（CVP）of patients were observed and recorded before pump injection of dexmedetomidine（T0）,1 min after tracheal intubation（T1）,10 min after anesthesia induction（T2）,30 min after anesthesia induction（T3）,wakeup（T4）,at the end of controlled anti-hypertension（T5）,at the end of operation（T6）,during tracheal extubation（T7）. Meanwhile,the wakeup experiment time,blood loss when wakeup,total amount of nitroglycerin,mean density of inhaled isoflurane,total amount of nitroglycerin,total blood loss,and post-operative wakeup time of both groups were recorded. The case number of post-operative delayed wakeup chill and dysphoria were calculated in both groups. RESULTS：Compared with at T0,HR of both groups at T1 and T7were faster,and MAP and CVP increased,and that of group S was more significant than that of group D（P〈0.05）. HR and MAP of both groups at T3 were significantly lower than T0（P〈0.05）. Compared to group D at T4,MAP and CVP of group S at T4 were increased and HR were faster（P〈0.05）;the wakeup experiment time and post-operative wakeup time of group D were shorter than those of group S（P〈0.05）;the blood loss when awaken and total blood loss were less than group S（P〈0.05）;the total amount of nitroglycerin,mean density of inhaled isoflurane and total amount of remifentanil were all lower than those of group S（P〈0.05）;the incidence of post-operative delayed wakeup,chill and dysphoria in group D were significantly lower than those of group S（P〈0.05）. CONCLUSIONS：The application of dexmedetomidine-assisted controlled anti-hypertension combined with high capacity hemodilution in spinal surgeries can bring more stable and effective controlled anti-hypertension. It can also reduce the amount of nitroglycerin,remifentanil,propofol and isoflurane significantly. It is a reliable and safe drug to be applied in assisted controlled anti-hypertension combined with high capacity hemodilution in spinal surgeries.