右美托咪定联合尼卡地平对老年脊柱手术患者控制性降压及炎症因子的影响

The effect of dexmedetomidine combined with nicardipine on the controlled hypotension and inflammatory factors in elderly patients undergoing spinal surgery

目的探讨右美托咪定联合尼卡地平对老年脊柱手术患者控制性降压及炎症因子的影响。方法前瞻性收集大连市第二人民医院2017年6月至2019年6月收治的老年脊柱手术患者100例(ASA分级Ⅰ~Ⅱ级),男56例,女44例,平均(70±6)岁。依据随机数字表法分为右美托咪定复合尼卡地平组(D+N组)和单用尼卡地平组(N组),每组50例,记录两组患者在麻醉前10 min(T_(1))、手术开始后10 min(T_(2))、手术开始后20 min(T_(3))、手术开始后30 min(T_(4))、停药时(T_(5))、手术结束(T_(6))时心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)以及术前和术后2 h、6 h的炎症因子白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)和术野清晰度、术中失血量、不良反应发生情况。结果D+N组T_(2)、T_(3)、T_(4)、T_(5)、T_(6)的HR[(78.5±5.8)次/min、(80.3±5.7)次/min、(81.6±5.9)次/min、(81.8±6.12)次/min、(80.1±8.6)次/min]、MAP[(58.2±3.3)mm Hg、(58.8±3.5)mmHg、(59.1±3.5)mm Hg、(84.1±6.6)mm Hg、(83.1±6.2)mm Hg]、CVP[(4.0±0.5)cm H_(2)O、(4.1±0.5)cm H_(2)O、(4.2±0.5)cm H_(2)O、(5.2±0.5)cm H_(2)O、(5.1±0.5)cm H_(2)O]低于N组[(85.6±6.5)次/min、(88.1±6.7)次/min、(89.3±6.9)次/min、(88.7±6.57)次/min、(86.4±6.4)次/min,(62.2±3.5)mm Hg、(63.3±3.5)mm Hg、(63.6±3.8)mm Hg、(92.6±6.4)mm Hg、(90.2±6.2)mm Hg,(4.7±0.5)cm H_(2)O、(4.9±0.5)cm H_(2)O、(5.0±0.5)cm H_(2)O、(7.1±0.7)cm H_(2)O、(6.6±0.7)cm H_(2)O],差异有统计学意义(F=58.462,F=72.428,F=76.921;F=167.562,F=204.382,F=257.691;均P<0.05);D+N组术野清晰度评分[(2.1±0.3)分]、术中失血量[(392±71)ml]低于N组[(2.6±0.3)分、(684±95)ml],差异有统计学意义(t=8.333,t=17.331,均P<0.05);D+N组术后2 h、6 h的IL-6[(182.5±20.3)pg/ml、(253.6±30.2)pg/ml]、TNF-α[(35.7±4.0)ng/ml、(44.4±5.7)ng/ml]、CRP[(27.2±2.2)mg/L、(42.1±5.0)mg/L]低于N组[(214.3±25.7)pg/ml、(342.4±36.1)pg/ml,(41.5±4.7)ng/ml、(56.4±6.2)ng/ml,(34.3±2.7)mg/L、(58.4±6.4)mg/L],差异有统计学意义(F=64.871,F=82.653,F=93.254;F=94.268,F=125.436,F=151.367;F=74.216,F=90.843,F=98.630;P均<0.05);D+N组不良反应发生率(10.0%)明显低于N组(30.0%),差异有统计学意义(χ^(2)=6.250,P<0.05)。结论右美托咪定联合尼卡地平可有效改善老年脊柱手术患者控制性降压效果,有利于改善患者血流动力学、术野清晰度,且可减少患者术后炎症应激反应及不良反应,值得临床推广。

Objective To discuss the effect of dexmedetomidine combined with nicardipine on the controlled hypotension and inflammatory factors in elderly patients undergoing spinal surgery.Methods 100 elderly patients undergoing spinal surgery(ASA physical statusⅠ-Ⅱ)in our hospital from June 2017 to June 2019 were selected,there were 56 males and 44 females with an age of(70±6)years,and they divided into dexmedetomidine combined with nicardipine group(D+N group)and nicardipine group(N group),50 minutes before anesthesia(T_(1)),10 minutes after operation(T_(2)),20 minutes after operation(T_(3)),30 minutes after operation(T_(4)),drug withdrawal(T_(5)),and at the end of operation(T_(6))and the inflammatory factors such as interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-alpha),C-reactive protein(CRP)at before operation and 2h,6h after operation and operative field definition,intraoperative blood loss,adverse reactions were recorded.Results The HR[(78.5±5.8)times/min,(80.3±5.7)times/min,(81.6±5.9)times/min,(81.8±6.12)times/min,(80.1±8.6)times/min],MAP[(58.2±3.3)mmHg,(58.8±3.5)mmHg,(59.1±3.5)mmHg,(84.1±6.6)mm Hg,(83.1±6.2)mm Hg]and CVP[(4.0±0.5)cm H_(2)O,(4.1±0.5)cm H_(2)O,(4.2±0.5)cm H_(2)O,(5.2±0.5)cm H_(2)O,(5.1±0.5)cm H_(2)O]in the D+N group at T_(2),T_(3),T_(4),T_(5),T_(6)were significantly lower than those in the N group[(85.6±6.5)times/min,(88.1±6.7)times/min,(89.3±6.9)times/min,(88.7±6.57)times/min,(86.4±6.4)times/min,(62.2±3.5)mm Hg,(63.3±3.5)mm Hg,(63.6±3.8)mm Hg,(92.6±6.4)mm Hg,(90.2±6.2)mm Hg,(4.7±0.5)cm H_(2)O,(4.9±0.5)cm H_(2)O,(5.0±0.5)cm H_(2)O,(7.1±0.7)cm H_(2)O,(6.6±0.7)cm H_(2)O],the difference was statistically significant(F=58.462,F=72.428,F=76.921;F=167.562,F=204.382,F=257.691;all P<0.05).The operative field definition score(2.1±0.3),intraoperative blood loss[(392±71)ml]in the D+N group were significantly lower than those in the N group[2.6±0.3,(684±95)ml],the difference was statistically significant(t=8.333,t=17.331,P<0.05).The levels of IL-6[(182.5±20.3)pg/ml,(253.6±30.2)pg/ml],TNF-alpha[(35.7±4.0)ng/ml,(44.4±5.7)ng/ml]and CRP[(27.2±2.2)mg/L,(42.1±5.0)mg/L]in the D+N group at 2 and 6h after operation were significantly lower than those in the N group[(214.3±25.7)pg/ml,(342.4±36.1)pg/ml,(41.5±4.7)ng/ml,(56.4±6.2)ng/ml,(34.3±2.7)mg/L,(58.4±6.4)mg/L],the difference was statistically significant(F=64.871,F=82.653,F=93.254;F=94.268,F=125.436,F=151.367;F=74.216,F=90.843,F=98.630;P<0.05).The incidence of adverse reactions(10.0%)in the D+N group was significantly lower than that in the N group(30.0%),the difference was statistically significant(χ^(2)=6.250,P<0.05).Conclusions Dexmedetomidine combined with nicardipine can effectively improve the controlled hypotensive effect of elderly patients undergoing spinal surgery,it is helpful to improve the hemodynamics and operative field definition of patients,and it can reduce the inflammatory stress reaction and adverse reactions after surgery,it’s worth for further clinical promotion.