右美托咪定和艾司洛尔辅助硝酸甘油在脊柱手术控制性降压作用比较的研究

Antihypertensive effects of dexmedetomidine and esmolol combined with nitroglycerin in spinal surgery

目的探究右美托咪定和艾司洛尔辅助硝酸甘油在脊柱手术控制性降压效果。方法选取择期行腰椎后路一个节段的减压植骨内固定术的患者90例,按照数字表法分为艾司洛尔+硝酸甘油组(E组)、右美托咪定+硝酸甘油组(D组)与硝酸甘油组(N组),每组各30例,观察三组患者各时点的平均动脉压、心率以及手术相关指标。结果与麻醉前比较,在降压开始10 min、降压开始30 min、降压开始60 min时,三组患者的平均动脉压均明显降低,差异有统计学意义(t分别=2.13、2.52、2.57;2.69、2.95、3.29;4.22、4.57、4.67,P均<0.05);在手术结束即刻、拔管后5 min时,D组与E组患者的平均动脉压均明显低于N组的,差异均有统计学意义(t分别=2.11、2.31、2.45、2.54,P均<0.05);与麻醉前比较,在降压开始10 min、降压开始30 min、降压开始60 min时,E组与D组患者的心率均明显降低,差异均有统计学意义(t分别=2.87、2.70、2.04;3.10、2.87、2.19,P均<0.05);在降压开始10 min、降压开始30 min、降压开始60 min、手术结束即刻、拔管后5 min时,D组与E组患者的心率均明显低于N组,差异均有统计学意义(t分别=5.77、5.63、5.70、5.66、4.11、4.08、3.91、3.86、2.61、2.56,P均<0.05);三组的手术时间、拔管时间比较,差异均无统计学意义(F分别=0.99、1.21,P均>0.05);E组与N组的输液量、乌拉地尔用量明显高于D组患者,术后苏醒时间明显短于D组患者,差异均有统计学意义(t分别=2.23、2.43、8.63、9.23、8.14、5.34,P均<0.05)。结论在脊柱手术中,右美托咪定和艾司洛尔辅助硝酸甘油均能够有效控制患者的平均动脉压和心率,减少脊柱手术出血,其中右美托咪定能够有效降低乌拉地尔用的使用,但术后苏醒时间相对延长。

Objective To explore antihypertensive effects of dexmedetomidine and esmolol combined with nitroglycerin in spinal surgery. Methods Ninety patients undergoing elective posterior lumbar decompression and bone graft within a segment fixation were assigned into esmolol combined with nitroglycerin group（group E）, dexmedetomidine combined with nitroglycerin group（group D） and nitroglycerin group（group N）with 30 cases in each. The mean arterial pressure, heart rate, and surgery-related indicators were observed and compared. Results Compared to before anesthesia, the MAP of three groups at 10 minutes, 30 minutes and 60 minutes after antihypertensive treatment were significantly decreased as well as the HR of group E and D（t =2.13, 2.52, 2.57, 2.69, 2.95, 3.29, 4.22, 4.57, 4.67; 2.87, 2.70, 2.04, 3.10,2.87, 2.19, P〈0.05）. The MAP of group D and E were significantly lower than the group N at ending of surgery and 5minutes after extubation（t=2.11, 2.31, 2.45, 2.54, P〈0.05）. HR of group D and E were significantly lower than group N at 10 minutes, 30 minutes, 60 minutes after antihypertensive treatment, ending of surgery and 5 minutes after extubation（t=5.77, 5.63, 5.70, 5.66, 4.11, 4.08, 3.91, 3.86, 2.61, 2.56, P〈0.05）. The time of operation and extubation among three groups were not statistically different（F=0.99, 1.21, P〉0.05）.The transfusion volume and urapidil dosage of group E and N were significantly higher than group D while the awakening time were significantly shorter than group D（t =2.23,2.43,8.63,9.23,8.14,5.34,P 〈0.05）. Conclusion Dexmedetomidine and esmolol combined with nitroglycerin caneffectively control the patient＇s mean arterial pressure and heart rate in spinal surgery and reduce the bleed-ing in surgery. Dexmedetomidine can effectively reduce urapidil dosage, but the postoperative recovery time is relatively extended.