右美托咪定在脊柱肿瘤手术控制性降压中的应用

Application of dexmedetomidine in controlled hypotension in spinal tumor surgery

目的探讨右美托咪定在脊柱肿瘤手术中控制性降压的临床疗效。方法选择2012年6月至2014年8月在我院择期在全身麻醉下行椎体肿瘤切除手术患者50例,采用随机数表法随机分为右美托咪定组（D组）和硝酸甘油组（N组）各25例,两组患者麻醉后于切皮前约10 min开始行控制性降压,D组输注右美托咪定,以0.6μg·kg-1·h-1的起始速度泵注;N组微量泵输注硝酸甘油,起始剂量为0.5μg·kg-1·min-1,使患者平均动脉压（MAP）较基础值下降达30%左右,且保证MAP大于55 mm Hg。术中维持麻醉深度指数（CSI）在40~60之间。记录手术时间、麻醉时间、控制性降压时间、术中失血量、术中输血量、术中补液量、尿量;基础值（T0）、控制性降压前（T1）、控制性降压后30 min（T2）和拔除气管导管时（T3）心率、血压;术中使用麻黄碱进行升压治疗的人数。结果术中两组患者失血量和输血量比较差异均无统计学意义（P〉0.05）;术中D组补液总量、输注胶体溶液及麻醉期间尿量明显多于N组,差异均有统计学意义（P〈0.05）;与N组比较,D组控制性降压30 min后心率和拔管时心率、血压较低,差异均有统计学意义（P〈0.05）;术中D组有14例,N组有13患者使用麻黄碱治疗,治疗后平均动脉压上升的绝对值分别为（14.1±2.3）mm Hg和（21.6±5.5）mm Hg,差异有统计学意义（P〈0.05）。结论右美托咪定用于脊柱肿瘤手术控制性降压时,术中心率及术后拔管时血压更平稳,术中需输注更多的胶体溶液,当较严重的低血压发生时应用麻黄碱升压的临床效果欠佳。

Objective To investigate the clinical efficacy of dexraedetomidine in controlled hypotension in spinal tu- mor surgery. Methods Fifty patients who received spinal minor surgery were randomly divided into two groups （n=25）,receiving continuous intravenous infusion of dexmedetomidine （group D, at initial dose of 0.6μg·kg^-1· h^-1） or sodium nitroglycerin （group N, at initial dose of 0.5 μg·kg^-1·min^-1） to control blood pressure （MAP was decreased by 30% of baseline, not less than 55 mmHg）. Two groups of patients received controlled hypotension after anesthesia before skin incision about 10 min. During the operation, anesthesia cerebral state index （CSI） was kept in 40-60. The operation time, anes- thesia time, controlled hypotension time, intraoperative blood loss, blood transfusion, total fluid infusion, and urine volume were recorded. The heart rate and blood pressure before anesthesia （To）, before controlled hypotension （T1）, af- ter 30 min controlled hypotension （T2）, at tracheal extubation （T3）, as well as the number of patients that needed ephed- rine treatment were also recorded. Results There were no significant differences between group D and group N in in- traoperative blood loss and blood transfusion （P〉0.05）. Compared with the group N, group D needs more fluid infu- sion and colloidal solution, with larger urine volume （P〈0.05）. The heart rate in group D was more slowly 30 min after controlled hypotension, and the heart rate and blood pressure were lower at extubation. Fourteen patients in group D and 13 patients in group N received ephedrine for treatment during operation, and the absolute value of increase in mean arterial blood pressure were （14.1±2.3） mmHg and （21.6±5.5） mmHg, respectively （P〈0.05）. Conclusion Us- ing dexmedetomidine for controlled hypotension in spinal tumor surgery, the heart rates are more stable in the opera- tion and blood pressure are more stable at extubation, but more colloidal solution is needed. Ephedrine should be ap- plied when severe hypotension occurs.