右美托咪定联合尼卡地平用于老年骨科手术患者控制性降压时对炎症因子的影响

Effect of Dexmedetomidine Combined with Nicardipine on Controlled Hypotension and Inflammatory Factors of Elderly Patients Undergoing Orthopedic Surgery

目的:探讨右美托咪定联合尼卡地平用于老年骨科手术患者控制性降压的临床疗效及其对炎症因子水平的影响。方法:选择2014年1月至2016年1月在我院行骨科手术的老年患者68例,随机分为两组,A组和B组,每组34例。A组患者接受尼卡地平控制性降压,B组患者在A组基础上静脉注射右美托咪定。比较两组患者的手术情况以及术中血流动力学指标,术中及术后血清IL-6(Interleukin-6)、TNF-α(Tumor necrosis factor-ɑ)以及CRP(C-reactive protein)的水平。结果:B组患者术中尼卡地平的使用剂量及术中出血量显著少于A组(P<0.05),术后苏醒时间及拔管时间较A组显著缩短(P<0.05),术中Fromme术野质量评分明显低于A组患者(P<0.05)。降压后5 min,A组患者的HR显著加快(P<0.05),B组患者HR相对稳定,且明显慢于A组(P<0.05);两组患者的MAP以及CVP显著低于降压前(P<0.05),且两组差异无统计学意义(P>0.05),A组患者在降压后30 min的MAP和CVP较B组显著升高(P<0.05)。两组患者术后不同时间点血清IL-6、TNF-α和CRP的水平显著上升(P<0.05),其中B组患者血清IL-6、TNF-α和CRP的水平较A组明显较低(P<0.05)。结论:右美托咪定联合尼卡地平用于老年患者行骨科手术时控制性降压的疗效显著,可有效降低尼卡地平的使用剂量,对患者血流动力学影响较小,并可减轻患者术后应激反应,利于患者术后恢复。

Objective： To explore the clinical curative effect of dexmedetomidine combined with nicardipine on controlled hypotension and inflammatory factors of elderly patients undergoing orthopedic surgery. Methods： 68 elderly patients undergoing orthope- dic surgery were enrolled in our hospital from January 2014 to January 2016, in which patients were randomly divided into two groups, Group A （n=34） accepted nicardipine for controlled hypotension during the operation, and Group B （n=34） adopted dexmedetomidine based on the patients in Group A. The operative condition and hemodynamics were compared between two groups, and the levels of IL-6 （Interleukin-6）, TNF-et （Tumor necrosis factor-tx） and CRP （C-reactive protein） in serum were detected respectively. Results： The usage dose of nicardipine for controlled hypotension and operative blood losing in Group B was significantly lower than that of Group A（P〈0. 05）. The time of recovery and tracheal extubation in Group B were shorter than those in Group A （P〈0.05）. The Fromme score of patients in Group B was significantly lower than those in Group A （P〈0.05）. The HR of Group A was significantly accelerated after decompres- sion for 5 min （P〈0.05）, and those in Group B was relatively stable, and the difference of HR at the same time point between Group A and Group B was significant （P〈0.05）. The MAP and CVP of patients in both groups were slower than before decompression（P〈0.05）, and no significant difference was found between two groups （P〉0.05）. After decompression for 30 min, the MAP and CVP of patients in Group A were significantly accelerated compared with Group B （P〈0.05）. The serum levels oflL-6, TNF-et and CRP were significantly increased at different time points after operation in the two groups （P〈0.05）, and the content in Group A were significantly lower than those of Group B （P〈0.05）. Conclusions： Dexmedetomidine combined with nicardipine for controlled hypotension in elderly patients undergoing orthopedic surgery was remarkable, which could decrease the usage dose of nicardipine and influence on the hemodynamic, and reduce the postoperative stress reactions, of which was beneficial to postoperative recovery of patients.