右美托咪定对后路腰椎椎间融合术患者组织灌注参数及血流动力学的影响

Effects of Dexmedetomidine on Tissue Perfusion Parameters and Haemodynamics in Patients Undergoing Posterior Lumbar Interbody Fusion

目的:探讨右美托咪定对后路腰椎椎间融合术患者组织灌注参数及血流动力学的影响。方法:选取2017年4月~2020年4月本院收治的120例择期拟行后路腰椎椎间融合术患者作为研究对象,按照随机数字表法将其分为对照组和观察组,各60例。观察组静脉注射盐酸右美托咪定注射液负荷量0.5μg/kg,随后以0.5μg/(kg·h)维持输注,对照组以同等体积0.9%氯化钠注射液代替右美托咪定。观察两组手术时间、术中丙泊酚用量、术中出血量、住院时间,分析两组诱导前10 min、诱导后1 min和插管后1 min的灌注指数(PI)、心率(HR)/平均动脉压(MAP)变化情况及不良反应发生情况。结果:两组手术时间、术中丙泊酚用量、术中出血量、住院时间比较无统计学差异(P>0.05)。与诱导前10 min比较,诱导后1 min和插管后1 min观察组PI上升、HR/MAP下降,对照组PI下降、HR/MAP上升,且观察组PI高于对照组、HR/MAP低于对照组(P<0.05)。两组不良反应总发生率比较无统计学差异(P>0.05)。结论:右美托咪定用于后路腰椎椎间融合术患者,有利于维持麻醉诱导期血流动力学稳定,改善组织灌注,且不会增加不良反应发生率,值得临床推广与应用。

Objective:To investigate the effect of dexmedetomidine on tissue perfusion parameters and hemodynamics in patients undergoing posterior lumbar interbody fusion.Methods:From April 2017 to April 2020,120 patients scheduled for posterior lumbar interbody fusion in our hospital were selected as the research subjects.They were divided into control group and observation group according to random number table,60 cases in each group.The observation group was injected with dexmedetomidine 0.5μg/kg,then was maintained with 0.5μg/(kg·h).The control group was given the same volume of 0.9%sodium chloride injection instead of dexmedetomidine.The operation time,intraoperative propofol dosage,intraoperative blood loss and hospital stay of the two groups were observed.The changes of perfusion index(PI),heart rate(HR)/mean arterial pressure(MAP)and adverse reactions were analyzed 10 min before induction,1 min after induction and 1 min after intubation.Results:There was no significant difference in operation time,intraoperative propofol dosage,intraoperative blood loss and hospital stay between the two groups(P>0.05).Compared with 10 min before induction,PI increased and HR/MAP decreased in the observation group at 1 min after induction and 1 min after intubation,while PI decreased and HR/MAP increased in the control group.PI in the observation group was higher than that in the control group and HR/MAP was lower than that in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:The application of dexmedetomidine in patients with posterior lumbar interbody fusion is beneficial to maintain hemodynamic stability during anesthesia induction,improve tissue perfusion,and will not increase the incidence of adverse reactions.It is worthy of clinical promotion and application.