右美托咪定抑制全身麻醉下单膝关节置换止血带反应的价值评估

Evaluation of the value of dexmedetomidine in inhibiting the tourniquet reaction during unilateral knee joint replacement under general anesthesia

目的探讨右美托咪定抑制全身麻醉下单膝关节置换止血带反应的价值评估。方法将2016年7月至2017年7月行全身麻醉下单膝关节置换术的90例患者随机分为2组,每组45例。2组采用相同的麻醉诱导和麻醉维持方法,观察组给予右美托咪定抑制止血带反应,对照组给予等量0. 9%氯化钠溶液,比较2组患者插入喉罩后(T0)、止血带加压时(T1)、加压后30 min(T2)、加压后60 min(T3)、松止血带时(T4)、松止血带后5 min(T5)时的HR、SBP、MAP、CO、SV变化,血流动力学异常发生率及相关药物使用情况,缺血再灌注损伤情况。结果观察组T1~T4时HR、SBP、MAP、CO、SV明显低于对照组,差异有统计学意义(P <0. 05),观察组T1~T4时HR、SBP、MAP、CO、SV与T0、T5相比无明显差异(P> 0. 05),对照组T1~T4时HR、SBP、MAP、CO、SV与T0、T5相比明显升高(P <0. 05);观察组高血压、心动过速等血流动力学异常发生率明显低于对照组,且阿托品、麻黄碱、尼卡地平等药物使用量与对照组相比有明显差异(P <0. 05);观察组T0、T4、松止血带后30 min(T6)的TNF-α、IL-8、MDA、SOD与对照组相比,观察组在T4及T6的TNF-α、IL-8、MDA水平均较对照组明显升高,而SOD明显降低,差异有统计学意义(P <0. 05)。结论右美托咪定对全身麻醉下单膝关节置换止血带反应的抑制效果显著,能有效稳定术中血流动力学各指标,减少波动,并抑制止血带解除后的缺血-再灌注损伤,具有积极的临床意义。

Objective To evaluate the value of dexmedetomidine in inhibiting the tourniquet reaction of unilateral knee joint replacement under general anesthesia. Methods Ninety patients undergoing unilateral knee joint replacement under general anesthesia in our hospital from July 2016 to July 2017 were randomly divided into two groups, with 45 patients in each group. The same anesthesia induction and anesthesia maintenance method were applied in both groups. The patients in the observation group were given dexmedetomidine to inhibit the tourniquet reaction, while those in the control group were given the same amount of 0.9% sodium chloride solution. The changes in HR, SBP, MAP, CO and SV in two groups were compared after insertion of the laryngeal mask （T0）, immediately after tourniquet inflation （T1）, 30 min after tourniquet inflation （T2）, 60 min after tourniquet inflation （T3）, immediately after tourniquet deflation （T4）, and 5 min after tourniquet deflation （T5）. Hemodynamic abnormalities and related drug use, ischemia and reperfusion injury were recorded. Results The levels of HR, SBP, MAP, CO and SV at T1-T4 in observation group were significantly lower than those in control group （ P 〈0.05）,and these indexes at T1-T4 were not significantly different from those at T0 and T5 in observation group （ P 〉0.05）, and those were significantly higher at T1-T4 than at T0 and T5 in control group （ P 〈0.05）. The incidence of hemodynamic abnormalities such as hypertension and tachycardia in observation group was significantly lower than that in control group, and the doses of atropine, ephedrine and nicardipine were significantly different from those in control group （ P 〈0.05）. The levels of TNF-α, IL-8, and MDA in observation group at T0, T4 and T6 were significantly higher than those in control group, however, SOD levels were significantly lower than those in control group （ P 〈0.05）. Conclusion Dexmedetomidine has a significant inhibitory effect on tourniquet reaction during unilateral knee joint replacement under general anesthesia, which can effectively stabilize intraoperative hemodynamic parameters, reduce fluctuations, and inhibit ischemia-reperfusion injury after tourniquet release. Thus, it is of positive significance in clinical practice.