右美托咪定复合尼卡地平在全身麻醉老年高血压患者全膝关节置换术的应用研究

Application of dexmedetomidine combined with nicardipine in total knee arthroplasty in elderly hypertensive patients under general anesthesia

目的探讨右美托咪定复合尼卡地平对全身麻醉下全膝关节置换术老年高血压患者的血流动力学和苏醒质量的影响。方法选择该院行全膝关节置换术的60例老年高血压患者为研究对象,分为右美托咪定组(D组)和右美托咪定复合尼卡地平组(DN组),每组30例。两组麻醉诱导和维持方法均相同,维持Narcotrend值为35~55。D组入手术室后0.5μg/kg右美托咪定静脉输注10 min,然后0.4μg·kg^(-1)·h^(-1)持续泵注,DN组入手术室后同D组,且于上止血带前5 min开始泵注0.5~1.5μg·kg^(-1)·min^(-1)尼卡地平,两组均在置入膝关节假体时停止泵注右美托咪定和尼卡地平。分别记录两组入手术室平静后(T0)、置入喉罩时(T1)、止血带充气加压后3 min(T2)、去除滑膜时(T3)、截骨时(T4)、安装假体时(T5)、松止血带后3 min(T6)和拔除喉罩后5 min(T7)血流动力学变化及Narcotrend值;记录两组血流动力异常、麻醉药物及血管活性药使用情况;记录手术视野和苏醒情况。结果两组苏醒时间比较,差异无统计学意义(P>0.05)。与D组比较,DN组丙泊酚、瑞芬太尼及七氟醚使用量减少,差异有统计学意义(P<0.05)。DN组在T2~T5及T7的收缩压(SBP)、舒张压(DBP)水平低于D组,差异有统计学意义(P<0.05)。与T0比较,D组在T1、T5、T6的SBP、DBP水平降低,而DN组在T1~T7时SBP、DBP水平降低,D组在T6、T7的心率增加,DN组在T6增加明显,差异有统计学意义(P<0.05)。D组发生高血压比例和降压药使用比例明显高于DN组,差异有统计学意义(P<0.05)。D组Richer镇静-躁动评分(SAS)为5分的比例高于DN组,手术视野清晰度低于DN组,差异有统计学意义(P<0.05)。结论右美托咪定复合尼卡地平有利于稳定老年高血压患者在全膝关节置换术中血流动力学,提供清晰手术视野,改善术后苏醒质量。

Objective To investigate the effects of dexmedetomidine compounded with nicardipine on the haemodynamics and quality of awakening in elderly hypertensive patients undergoing total knee arthroplasty under general anesthesia.Methods A total of sixty elderly hypertensive patients undergoing total knee arthroplasty in this hospital were selected for the study and divided into dexmedetomidine group(group D)and dexmedetomidine combined with nicardipine group(group DN),30 patients in each group.The induction and maintenance of anesthesia were the same in both groups,with Narcotrend values of 35-55 being maintained.0.5μg/kg of dexmedetomidine was infused intravenously for 10 min after admission to group D,followed by 0.4μg·kg^(-1)·h^(-1) continuous pumping.The pumping of 0.5-1.5μg·kg^(-1)·min^(-1) of nicardipine was started 5 min before the tourniquet was applied,and the pumping of dexmedetomidine and nicardipine was stopped at the time of knee prosthesis placement in both groups.The haemodynamic changes and Narcotrend values of the two groups were recorded after room calming(T0),at the time of mask placement(T1),3 min after inflation and pressure(T2),at the time of synovial removal(T3),at the time of osteotomy(T4),at the time of prosthesis installation(T5),3 min after tourniquet release(T6)and 5 min after removal of the mask(T7),respectively.Hemodynamic abnormalities,anesthetic and vasoactive drug use were recorded in both groups;surgical visualization and awakening were recorded.Results There was no statistically significant difference in the time to awakening between the two groups(P>0.05).Systolic blood pressure(SBP)and diastolic blood pressure(DBP)levels in T2-T5 and T7 were lower in group DN than in group D,and the difference was statistically significant(P<0.05).Compared with T0,SBP and DBP levels decreased in group D at T1,T5 and T6,while SBP and DBP decreased in group DN at T1-T7.Heart rate increased in group D at T6 and T7 and increased significantly in group DN at T6,with statistically significant differences(P<0.05).The incidence of hypertension and the use of antihypertensive drugs in group D were significantly higher than those in group DN,and the difference was statistically significant(P<0.05).The proportion of Richer Calm-Agitation score(SAS)of 5 in group D was higher than that in group DN,and the clarity of surgical field of vision was lower than that in group DN,and the difference was statistically significant(P<0.05).Conclusion Dexmedetomidine compounded with nicardipine is beneficial for stabilizing hemodynamics in elderly hypertensive patients during total knee arthroplasty,providing a clear surgical field and improving the quality of postoperative awakening.