硝酸甘油联合右美托咪定在老年患者全髋关节置换术中的控制性降压效果

Effect of nitroglycerin combined with dexmedetomidine on controlled hypotension in elderly patients with total hip replacement

目的：探讨硝酸甘油联合右美托咪定在老年患者全髋关节置换术中的控制性降压效果。方法选取2012年5月—2015年2月在内江市市中区人民医院行全麻下髋关节置换术的老龄患者144例，随机分为研究组与对照组，各72例。对照组患者予以硝酸甘油控制性降压，研究组患者予以硝酸甘油联合右美托咪定控制性降压。观察两组患者麻醉诱导前（T0）、硝酸甘油给药15min（T1）、硝酸甘油给药30min（T2）、硝酸甘油给药45min（T3）、硝酸甘油停药15min（T4）的心率和平均动脉压变化情况、硝酸甘油用量、平均动脉压降至既定目标耗时及术野满意率。结果时间与治疗方法有交互作用（P ﹤0.05），组间比较，差异均有统计学意义（P ﹤0.05），时间间比较，差异均有统计学意义（P ﹤0.05），T0、T4节点两组患者心率比较，差异无统计学意义（P ﹥0.05），T1~3节点研究组患者心率低于对照组，差异有统计学意义（P ﹤0.05）；时间与治疗方法有交互作用（P ﹤0.05），组间比较，差异均有统计学意义（P ﹤0.05），时间间比较，差异均有统计学意义（P ﹤0.05），T0、T3、T4节点两组患者平均动脉压比较，差异无统计学意义（P ﹥0.05），T1~2节点研究组患者平均动脉压低于对照组，差异有统计学意义（ P ﹤0.05）；研究组患者硝酸甘油用量少于对照组，平均动脉压降至既定目标耗时短于对照组，差异有统计学意义（ P ﹤0.05）；研究组患者术野满意率高于对照组，差异有统计学意义（ P ﹤0.05）。结论硝酸甘油联合右美托咪定在老年患者全髋关节置换术中的控制性降压的效果显著，可稳定患者心率，减少硝酸甘油用量及术中出血量，提高术野满意率。

Objective To explore the effect of nitroglycerin combined with dexmedetomidine on controlled hypotension in elderly patients with total hip replacement. Methods A total of 144 elderly patients with total hip replacement were selected in the Central District People＆#39;s Hospital of Neijiang from May 2012 to February 2015,they were randomly divided into study group and control group,72 cases in each group. Control group were given nitroglycerin,study group were given nitroglycerin and dexmedetomidine. Before anesthesia induction（T0 ）,administration of nitroglycerin 15min（T1 ）,administration of nitro-glycerin 30min（T2 ）,administration of nitroglycerin 45min（T3 ）,drug withdrawal of nitroglycerin 15min（T4 ）,heart rate and mean arterial pressure,nitroglycerin doses,mean arterial pressure drop to target time - consuming and surgery field satisfac-tion rate between the two groups were compared. Results Interaction with the time and treatment method（P ﹤ 0. 05）,com-parison among groups（P ﹤ 0. 05）,comparison between time（P ﹤ 0. 05）,T0 ,T4 ,heart rate showed no significant differ-ences between the two groups（P ﹥ 0. 05）,T1 ~ 3 ,heart rate of study group were lower than those of control group（P ﹤ 0. 05）;interaction with the time and treatment method（P ﹤ 0. 05）,comparison among groups（P ﹤ 0. 05）,comparison between time （P ﹤ 0. 05）,T0 ,T3 ,T4 ,mean arterial pressure showed no significant differences between the two groups（ P ﹥ 0. 05）, T1 ~ 2 ,mean arterial pressure of study group were lower than those of control group（P ﹤ 0. 05）;nitroglycerin doses of study group was less than that of control group,mean arterial pressure drop to target time - consuming of study group was shorter than that of control group（P ﹤ 0. 05）;surgery field satisfaction rate of study group was higher than that of control group（ P ﹤0. 05）. Conclusion Nitroglycerin combined with dexmedetomidine has notable controlled hypotension effect in elderly patients with total hip replacement,can stabilize the patients＇ heart rate,reduce dosage of nitroglycerin and intraoperative blood loss, improve surgery field satisfaction rate.