右美托咪定联合硝普钠用于正颌手术控制性降压的临床效果

Clinical efficacy of Dexmetidine combined with Sodium Nitroprusside in controlled hypotension during orthognathic surgery

目的分析右美托咪定联合硝普钠用于正颌手术控制性降压的临床效果。方法 186例行正颌手术治疗患者,按照随机数字表法分为对照组和观察组,各93例。对照组术前给予硝普钠,观察组术前给予右美托咪定联合硝普钠。比较两组临床效果。结果对照组患者泵注硝普钠后5 min(T2)、泵注硝普钠后10 min(T3)、泵注结束后5 min(T4)、泵注结束后10 min(T5)收缩压分别为(98.37±9.56)、(83.82±7.62)、(122.89±13.27)、(139.69±15.17)mm Hg(1 mm Hg=0.133 k Pa),均低于入手术室时(T1)的(145.52±17.13)mm Hg,差异具有统计学意义(P<0.05);观察组患者T2、T3、T4、T5收缩压分别为(99.54±7.51)、(82.50±7.43)、(113.71±6.19)、(118.36±6.30)mm Hg,均低于T1的(147.26±12.28)mm Hg,差异具有统计学意义(P<0.05)。对照组患者T2、T3、T4、T5舒张压分别为(67.62±6.32)、(64.17±5.94)、(79.60±4.78)、(83.43±5.81)mm Hg,均低于T1的(93.47±5.62)mm Hg,差异具有统计学意义(P<0.05);观察组患者T2、T3、T4、T5舒张压分别为(66.03±7.12)、(58.29±4.72)、(65.14±5.11)、(73.02±4.41)mm Hg,均低于T1的(94.54±4.91)mm Hg,差异具有统计学意义(P<0.05)。观察组患者T4、T5收缩压均低于对照组,差异具有统计学意义(P<0.05);观察组患者T3、T4、T5舒张压均低于对照组,差异具有统计学意义(P<0.05)。观察组患者达目标血压时间为(5.43±1.67)min,短于对照组的(7.48±2.31)min,单位时间硝普钠用量、术中出血量分别为(2.71±0.72)μg/(kg·min)、(214.27±25.41)ml,均少于对照组的(3.76±0.69)μg/(kg·min)、(412.53±85.64)ml,差异具有统计学意义(P<0.05)。对照组患者麻醉不良反应发生率为35.48%,观察组患者麻醉不良反应发生率为7.53%,观察组患者麻醉不良反应发生率低于对照组,差异具有统计学意义(P<0.05)。结论与硝普钠单独使用相比,右美托咪定联合硝普钠应用于正颌手术中可有效提高控制性降压效果,用药简便,控压稳定,减少术中出血量,同时可减少硝普钠使用剂量及麻醉不良反应,安全性较高。

Objective To analyze the clinical application of Dexmetidine combined with Sodium Nitroprusside in controlled hypotension during orthognathic surgery.Methods A total of 186 patients with orthognathic surgery were divided into control group and observation group according to the random number table method,93 cases in each group.The control group received Sodium Nitroprusside before surgery,the observation group received Dexmetomidine combined with Sodium Nitroprusside before surgery.The clincial effects of the two groups were compared.Results The systolic blood pressure of the control group at 5 min after infusion of Sodium Nitroprusside(T2),10 min after infusion of Sodium Nitroprusside(T3),5 min after pump injection(T4)and 10 min after pump injection(T5)were(98.37±9.56),(83.82±7.62),(122.89±13.27)and(139.69±15.17)mm Hg(1 mm Hg=0.133 kPa)respectively,which were significantly lower than(145.52±17.13)mm Hg at the time of entering the operating room(T1),the differences were statistically significant(P<0.05).The systolic blood pressure of the observation group at T2,T3,T4 and T5 were(99.54±7.51),(82.50±7.43),(113.71±6.19),(118.36±6.30)mm Hg respectively,which were significantly lower than(147.26±12.28)mm Hg at T1,the differences were statistically significant(P<0.05).The diastolic blood pressure of the control group at T2,T3,T4 and T5 were(67.62±6.32),(64.17±5.94),(79.60±4.78),(83.43±5.81)mm Hg respectively,which were significantly lower than(93.47±5.62)mm Hg at T1,the differences were statistically significant(P<0.05).The diastolic blood pressure of the observation group at T2,T3,T4 and T5 were(66.03±7.12),(58.29±4.72),(65.14±5.11),(73.02±4.41)mm Hg respectively,which were significantly lower than(94.54±4.91)mm Hg at T1,the differences were statistically significant(P<0.05).The systolic blood pressure of the observation group at T4 and T5 were significantly lower than those of the control group,the differences were statistically significant(P<0.05).The diastolic blood pressure of the observation group at T3,T4 and T5 were significantly lower than those of the control group,the differences were statistically significant(P<0.05).The time to reach the target blood pressure in the observation group was(5.43±1.67)min,which was significantly shorter than(7.48±2.31)min in the control group,and the dosage of Sodium Nitroprusside and intraoperative blood loss in the observation group were(2.71±0.72)μg/(kg·min)and(214.27±25.41)ml respectively,which were significantly less than(3.76±0.69)μg/(kg·min)and(412.53±85.64)ml in the control group,the differences were statistically significant(P<0.05).The incidence of adverse reactions of the control group was 35.48%,and that in the observation group was 7.53%.The incidence of adverse reactions in the observation group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion Compared with Sodium Nitroprusside alone,Dexmetomidine combined with Sodium Nitroprusside in orthognathic surgery can effectively improve the effect of controlled hypotension,it is simple to use,stable in pressure control,and can reduce intraoperative blood loss.At the same time,it can reduce the dosage of Sodium Nitroprusside and adverse reactions of anesthesia,and has higher safety.