艾司氯胺酮+右美托咪定+尼卡地平对老年高血压髋关节置换术麻醉效果的影响

The Effect of Ketamine,Dexmedetomidine,and Nicardipine on Anesthesia in Elderly Hypertensive Hip Replacement Surgery

目的探讨艾司氯胺酮+右美托咪定+尼卡地平对老年高血压髋关节置换术麻醉中的应用效果。方法选取2021年6月—2023年5月新疆生产建设兵团第二师焉耆医院收治的80例老年高血压髋关节置换术患者作为研究对象,依据不同的麻醉方法将其分为对照组(n=30)、观察A组(n=25)和观察B组(n=25)。所有患者均进行常规全身麻醉诱导,对照组在诱导前应用尼卡地平0.5μg/kg·min静脉持续泵注,观察A组诱导前使用尼卡地平0.5μg/kg·min静脉持续泵注与0.5μg/kg右美托咪定静脉泵注10 min,随后维持0.4μg/kg·h的速度持续泵注,观察B组除采取观察A组措施之外,在诱导中增加0.35 mg/kg艾司氯胺酮静注,并以0.3~0.4 mg/kg·h的速度维持。比较三组患者入室时(T1)、手术开始即刻(T2)、手术开始后20 min(T3)、手术结束即刻(T4)的血氧饱和度(SPO2)、收缩压(SBP)、舒张压(DBP)、心率(HR)变化、其术中丙泊酚用量、术中瑞芬太尼用量、手术时间、术中出血量以及术后苏醒时间、不良反应发生率。结果T1、T2、T3和T4时间三组患者SPO2比较,差异无统计学意义(P>0.05),T1和T4时间三组患者HR、DBP、SBP比较,差异无统计学意义(P>0.05)。T2和T3时间,观察B组HR、DBP、SBP低于观察A组和对照组,差异有统计学意义(P<0.05);三组患者手术时间、术中出血量、术后苏醒时间比较,差异无统计学意义(P>0.05),观察B组术中丙泊酚、瑞芬太尼用量明显低于对照组和观察A组,差异有统计学意义(P<0.05);观察B组不良反应发生率低于观察A组与对照组,差异有统计学意义(P<0.05)。结论对老年高血压髋关节置换术患者采取艾司氯胺酮+右美托咪定+尼卡地平辅助全身麻醉可稳定患者术中生命体征情况,术中所需麻醉药用量均减少,降低麻醉不良反应发生率。

Objective To explore the application eff ect of Ketamine+Dexmedetomidine+Nicardipine in the anesthesia of hip Joint replacement for elderly patients with hypertension.Methods 80 elderly patients with hypertension undergoing hip replacement surgery admitted to Yanqi Hospital of the Second Division of Xinjiang Production and Construction Corps from June 2021 to May 2023 were selected for research and analysis.They were divided into control group(n=30),observation group A(n=25),and observation group B(n=25)based on different anesthesia methods.All patients underwent routine general anesthesia induction,while the control group received nicardipine continuous intravenous infusion of 0.5μg/kg•min before induction,observe group A using nicardipine continuous intravenous infusion of 0.5μg/kg•min and 0.5μg/kg dexmedetomidine intravenously pumped for 10 minutes before induction,followed by maintenance of continuously pump at a speed of 0.4μg/kg•h,observe Group B,in observation group B,in addition to the measures taken in observation group A,0.35mg/kg of Ketamine was added during induction,and maintained at a rate of 0.3~0.4mg/kg·h.Compare the changes in blood oxygen saturation(SPO2),systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate(HR)of three groups of patients at entry(T1),immediately after surgery(T2),20 minutes after surgery(T3),and immediately after surgery(T4).Compare the intraoperative propofol dosage,intraoperative remifentanil dosage,surgery time,intraoperative bleeding volume,and postoperative recovery time,and finally compare the incidence of adverse reactions.Results There was no signifi cant diff erence in SPO2 among the three groups of patients at T1,T2,T3,and T4 time.There was no signifi cant diff erence in HR,DBP,and SBP among the three groups of patients at T1 and T4 time(P>0.05).HR,DBP,and SBP in Group B were lower than those in Group A and the control group at T2 and T3 time(P<0.05);There was no signifi cant diff erence in surgical time and postoperative recovery time among the three groups of patients(P>0.05).There was no signifi cant diff erence in surgical time,intraoperative bleeding volume,and postoperative recovery time among the three groups of patients(P>0.05).The intraoperative dosage of propofol and remifentanil in Group B was signifi cantly lower than that in the control group and Observation Group A(P<0.05);The statistical results of adverse reactions showed that compared to the observation of Group A and the control group,there were fewer observations of Group B(P<0.05).Conclusion For elderly hypertensive patients undergoing hip arthroplasty,using ketamine,dexmedetomidine,and nicardipine as an auxiliary general anesthesia can stabilize the patient's intraoperative vital signs,reduce the amount of anesthesia required during the surgery,and reduce the incidence of adverse reactions to anesthesia.