瑞芬太尼结合右美托咪定对年龄≥60岁膝关节置换术患者术中控制性降压效果研究

Effect of remifentanil combined with dexmedetomidine on intraoperative controlled hypotension in patients aged more than 60 years undergoing total knee arthroplasty

目的研究瑞芬太尼结合右美托咪定对年龄≥60岁膝关节置换术患者术中控制性降压效果的影响。方法采用均衡、随机化原则将2021年3月至2023年2月在阜南县人民医院接受膝关节置换术治疗的104例年龄≥60岁患者划分为对照组和试验组,每组52例。术中对照组采用单一右美托咪定降压方案,而试验组采用瑞芬太尼结合右美托咪定降压方案,对比2组术中不同时间段(麻醉前、插管前、插管后、术中10 min、术中30 min、停止药3 min)的血压(收缩压、舒张压)、心率;同时,对比2组患者达到控制性降压目标时间、麻醉恢复质量。结果在插管前、插管后、术中10 min、术中30 min时刻,试验组的收缩压、舒张压、心率均低于对照组(P<0.05);试验组达到控制性降压目标时间短于对照组,其麻醉恢复质量评分高于对照组(P<0.05)。结论在年龄≥60岁膝关节置换术患者中采用瑞芬太尼结合右美托咪定,能提高控制性降压效果和麻醉恢复质量。

Objective To study the effect of remifentanil combined with dexmedetomidine on intraoperative controlled hypotension in patients aged more than 60 years undergoing total knee arthroplasty(TKA).Methods This was a parallel,randomized study involving 104 patients aged more than 60 years who received TKA in Funan county people’s hospital from March 2021 to February 2023,they were assigned into control group(n=52)and experimental group(n=52).All patients were managed by dexmedetomidine during operation,and those in experimental group were additionally given remifentanil.The systolic blood pressure(SBP)and diastolic blood pressure(DBP),and heart rate at different intraoperative time periods(before anesthesia,before and after intubation,10 min intraoperatively,30 min intraoperatively,3 min after discontinuation),the time to achieve the controlled hypotensive target,and the quality of anesthesia recovery between groups were compared.Results Before and after intubation,and at 10 min and 30 min intraoperatively,the experimental group had significantly lower SBP,DBP and heart rate,shorter the time to achieve the controlled hypotensive target,higher quality of anesthesia recovery than the control group(all P<0.05).Conclusion The combination of remifentanil and dexmedetomidine can improve the effect of controlled hypotension and the quality of anesthesia recovery in patients aged more than 60 years undergoing TKA.