不同剂量右美托咪定复合舒芬太尼对胸腰椎骨折全身麻醉患者血流动力学及应激反应的影响

Effects of different doses of dexmedetomidine combined with sufentanil on hemodynamics and stress response in patients with thoracolumbar fractures undergoing general anesthesia

目的 探究不同剂量右美托咪定复合舒芬太尼对胸腰椎骨折全身麻醉患者血流动力学及应激反应的影响。方法 选取2019年3月至2020年3月陕西省核工业二一五医院收治的106例胸腰椎骨折拟行全身麻醉患者为研究对象,采用随机数表法分为低剂量组[右美托咪定0.5μg/(kg·h)+舒芬太尼0.02μg/(kg·h),55例]和高剂量组[右美托咪定0.8μg/(kg·h)+舒芬太尼0.02μg/(kg·h) 51例]。比较两组患者各时间点的Ramsay评分、血流动力学指标及手术相关指标;比较两组患者手术前后的应激反应指标、氧化损伤指标、血小板活化指标和术后不良反应发生情况。结果 高剂量组患者麻醉诱导后(T1)、拔管时(T2)的Ramsay评分分别为(3.65±0.59)分、(3.02±0.34)分,明显高于低剂量组的(3.30±0.51)分、(2.89±0.32)分,差异均有统计学意义(P<0.05);高剂量组患者的自主呼吸恢复时间及苏醒时间分别为(9.27±1.20) min、(21.69±3.56) min,明显长于低剂量组的(8.68±1.13) min、(18.97±3.42) min,差异均有统计学意义(P<0.05);高剂量组患者T2的心率(HR)、平均动脉压(MAP)分别为(85.26±5.17)次/min、(92.04±4.13) mmHg,明显低于低剂量组的(93.12±3.03)次/min、(96.18±4.09) mm Hg,差异均有统计学意义(P<0.05);高剂量组患者术后皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)水平分别为(672.28±9.63) nmol/L、(643.19±29.16) pmol/L、(3 397.25±92.06) pmol/L,明显低于低剂量组的(680.53±10.24) nmol/L、(668.22±29.83) pmol/L、(3 519.08±89.61) pmol/L,差异均有统计学意义(P<0.05);高剂量组患者术后谷胱甘肽过氧化物酶(GSH-Px)为(403.26±35.04) U/L,明显高于低剂量组的(375.39±30.18) U/L,术后脂质过氧化物(LPO)、血栓素A2 (TXA2)、血小板颗粒蛋白140 (GMP140)水平分别为(7.75±0.79)μmol/L、(468.37±50.59) ng/L、(30.05±3.87)μg/L,明显低于低剂量组的(8.61±0.83)μmol/L、(513.24±50.11) ng/L、(34.17±3.96)μg/L,差异均有统计学意义(P<0.05);观察组患者术后不良反应总发生率为1.82%,略低于对照组的5.88%,但差异无统计学意义(P>0.05)。结论 相比于低剂量右美托咪定,应用高剂量右美托咪定复合舒芬太尼对胸腰椎骨折患者进行全身麻醉,更能减轻应激反应及氧化损伤,并可减少血流动力学波动,抑制血小板活性。

Objective To explore the effects of different doses of dexmedetomidine combined with sufentanil on hemodynamics and stress response in patients with thoracolumbar fractures undergoing general anesthesia.Methods A total of 106 patients with thoracolumbar fractures undergoing general anesthesia in the 215thHospital of Shaanxi Nuclear Industry were enrolled as the research objects between March 2019 and March 2020. They were divided into low-dose group dexmedetomidine 0.5 μg/(kg·h) + sufentanil 0.02 μg/(kg·h), 55 cases and high-dose group dexmedetomidine 0.8 μg/(kg·h) + sufentanil 0.02 μg/(kg·h), 51 cases by random number table method. Ramsay score, hemodynamics indexes, and surgery-related indexes between the two groups were compared at different time points. The changes in stress response indexes, oxidative damage indexes, and platelet activation indexes before and after surgery in both groups were also compared, as well as the occurrence of postoperative adverse reactions. Results Ramsay scores after anesthesia induction(T1) and at extubation(T2) in high-dose group were(3.65±0.59) points and(3.02±0.34) points, significantly higher than(3.30±0.51) points and(2.89±0.32) points in low-dose group(P<0.05). Recovery time of spontaneous breathing and wake-up time were(9.27±1.20) min and(21.69±3.56) min, significantly longer than(8.68±1.13) min,(18.97±3.42) min in low-dose group(P<0.05). The heart rate(HR) and mean arterial pressure(MAP) at T2 in high-dose group were(85.26 ± 5.17) times/min and(92.04 ± 4.13) mmHg, significantly lower than(93.12 ± 3.03) times/min and(96.18±4.09) mmHg in low-dose group(P<0.05). After surgery, levels of cortisol(Cor), epinephrine(E), and norepinephrine(NE) in high-dose group were(672.28±9.63) nmol/L,(643.19±29.16) pmol/L, and(3 397.25±92.06) pmol/L, significantly lower than(680.53±10.24) nmol/L,(668.22±29.83) pmol/L,(3 519.08±89.61) pmol/L in low-dose group(P<0.05), and level of glutathione peroxidase(GSH-Px) in high-dose group was(4 03.26±35.04) U/L, significantly higher than(375.39±30.18) U/L in low-dose group(P<0.05). After surgery, levels of lipid peroxide(LPO), thromboxane A2(TXA2), and platelet α granular membrane protein 140(GMP140) in high-dose group were(7.75 ± 0.79) μ mol/L,(468.37±50.59) ng/L, and(30.05±3.87) μg/L, significantly lower than(8.61±0.83) μmol/L,(5 13.24±50.11) ng/L,(34.17±3.96) μg/L in low-dose group(P<0.05). There was no significant difference in the total incidence of adverse reactions between observation group and control group(1.82% vs 5.88%, P>0.05). Conclusion Compared with low-dose dexmedetomidine, the application of high-dose dexmedetomidine combined with sufentanil in general anesthesia for patients with thoracolumbar fractures undergoing general anesthesia can more relieve stress response and oxidative damage, reduce hemodynamics fluctuations and inhibit platelet activity.