右美托咪定在全身麻醉下单膝关节置换止血带反应中的抑制效果研究

The inhibitory effects of dexmedetomidine on tourniquet reaction in single knee replacement under general anesthesia

目的探讨右美托咪定在全身麻醉下单膝关节置换止血带反应中的抑制效果研究。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患者90例随机分为2组,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、BIS值变化,并记录各时间点疼痛情况,自主呼吸恢复时间、苏醒时间及拔管时间。结果观察组T1～T4时HR、SBP、MAP、BIS值明显低于对照组,差异有统计学意义(P <0. 05),对照组T1～T4时HR、SBP、MAP、BIS值均较T0、T5时显著升高(P <0. 05),而观察组T1～T4时HR、SBP、MAP、BIS值与T0、T5比较差异无统计学意义(P>0. 05);观察组T2～T5时VAS疼痛评分均明显低于对照组,差异有统计学意义(P <0. 05),观察组T3～T4时VAS疼痛评分高于其他时间点,而对照组T3～T5时VAS疼痛评分高于其他时间点,差异有统计学意义(P <0. 05);观察组自主呼吸恢复时间、苏醒时间、拔管时间及定向力恢复时间与对照组比较明显缩短,差异有统计学意义(P <0. 05)。结论右美托咪定在全身麻醉下单膝关节置换止血带反应的抑制效果显著,能降低血压升高发生率,降低止血带疼痛反应,稳定血流动力学,促进术后的苏醒质量,具有积极的临床意义。

Objective To explore the inhibitory effects of dexmedetomidine on tourniquet reaction in single knee replacement under general anesthesia.Methods A total of 90 patients who underwent single knee replacement under general anesthesia in our hospital from July 2016 to July 2017 were randomly divided into two groups,and the patients in both groups were treated by the same anesthesia induction and anesthesia maintain method,and the patients in observation group were given dexmedetomidine to inhibit the tourniquet reaction,however,the patients in control group were given equivalence 0.9%sodium chloride solution.The changes of HR,SBP,MAP,BIS value after inserting laryngeal mask(T0),tourniquet compression(T1),at 30min after tourniquet compression(T2),at 60min after tourniquet compressionp(T3),tourniquet released(T4)and at 5min after tourniquet released(T5)were observed and compared between the two groups,moreover,the pain degree in different time points,spontaneous breathing recovery time,awaken time and extubation time were observed and compared between the two groups.Results The levels of HR,SBP,MAP,BIS value during T1~T4 in observation group were significantly lower than those in control group(P<0.05),moreover,which in control group at T0 and T5 were increased significantly(P<0.05).However there were no significant differences in the levels of HR,SBP,MAP,BIS value in observation group between T1~T4 and T0,T5(P>0.05).The VAS pain score during T2~T5 in observation group were significantly lower than those in control group(P<0.05),which in observation group at T3,T4 were significantly higher than those at the other time points,Moreover the spontaneous breathing recovery time,awaken time and extubation time were significantly shortened,as compared with those in control group(P<0.05).Conclusion The inhibitory effects of dexmedetomidine on tourniquet reaction in single knee replacement under general anesthesia are quite significant,which can relieve the tourniquet pian reaction,stabilize hemodynamics,promote the postoperative revival quality,which has positive clinical significance.