于国军,陈文超,袁哲
YU Guojun,CHEN Wenchao,YUAN Zhe

• 1:河南省洛阳正骨医院河南省骨科医院麻醉科

摘要(Abstract)：

目的:研究盐酸右美托咪定(DEX)对多发性骨折术中血流动力学的影响。方法:选取骨科多发性骨折择期行内固定的患者100例,随机均分为观察组和对照组;观察组患者在麻醉诱导开始时给予负荷剂量为1μg/kg的DEX,而后以0.2μg/(kg·h)的速度静脉脉泵维持至手术结束前30 min,对照组以同样的方式给予相等剂量的生理盐水;观察两组患者麻醉诱导前(t_0)、气管插管时(t_1)、气管插管后(t_2)、切皮时(t_3)、复位固定时(t_4)、手术结束时(t_5)、手术结束后15 min(t_6)、手术结束后30 min(t_7)及手术结束后45 min(t_8)时的心率(HR)、收缩压(SBP)、舒张压(DBP)和血氧饱和度(SpO_2)的变化,同时观察患者失血量、浓缩红细胞(PRBCs)输入量、血红蛋白浓度(Hb%)和红细胞比容(Htc)的变化,并比较两组患者麻醉药物用量、麻醉效果及相关不良反应。结果:观察组t_2~t_8HR值低于t0,对照组t_1~t_8HR值高于t_0(P<0.05),组间比较,对照组t1~t8HR值高于观察组;观察组t_6~t_8SBP值小于t_0,t_6、t_7(P<0.05);对照组t_1~t_8SBP值均明显大于t_0(P<0.05)。对照组t_1~t_8SBP值大于观察组;观察组患者在t_5~t_8DBP值小于t_0(P<0.05);对照组t_1~t_8DBP值大于t0。对照组t_1~t_8DBP值大于观察组(P<0.05)。观察组术中失血量低于对照组(P<0.05);对照组PRBCs输入量高于观察组(P<0.05);观察组术中、术后Hb%值和Htc值大于对照组(P<0.05);观察组麻醉药物丙泊酚、芬太尼及罗库溴铵的使用量和不良反应发生率低于对照组(P<0.05);观察组拔管时间和苏醒时间明显长于对照组(P<0.05)。结论:DEX运用于骨科多发性骨折患者术中,可减轻患者术中及术后清醒期血流动力学波动,减少术中出血量、术后输血量、麻醉药物使用量以及麻醉期间不良反应。
Objective:To study the hemodynamics effects of dexmedetomidine hydrochloride on intraoperative patients with multiple fractures.Methods:100 patients with multiple fractures ready to undergo selective internal fixation were collected as the research object and were randomly divided into the observation group and the control group,50 cases in each group.The observation group at the beginning of anesthesia induction were given dexmedetomidine hydrochloride at the dose of 1 ug/kg and then maintained the vein pump at the speed of 0.2 ug/(kg·h) till 30 min.before the end of operation; The control group were given the same dose of normal saline in the same way.The change of HR,SBP,DBP and SPO_2 of two groups in t_0(before anesthesia induction),t_1(endotracheal intubation),t_2(after endotracheal intubation),t_3(cut),t_4(fixed reset),t_5(at the end of surgery),t_6(15 min after the surgery),t_7(after 30 min) and t_8(45 min after surgery).Then the hemorrhage volume,PRBCs input amount,the change of Hb% and Htc,the narcotic drug dosage,anaesthesia effect and related adverse reaction of the two groups were observed and compared.Results:The value of t_2~t_8 HR in the observation group was lower than t_0,and the value of t_1~ t_8 HR in the control group was more than t_0(P < 0.05),higher than that of the observation group.The t_6~ t_8 HR value in the observation group was higher than in controls; The t_6~ t_8 SBP value in the observation group was less than t_0,t_6,and t_7(P < 0.05).The value of t_1~ t_8 SBP in the control group was significantly more than t_0(P < 0.05),higher than that in the observation group.The t_5~ t_8 DBP values in the observation group were less than t_0(P < 0.05).The value of t_1~ t_8 DBP in the control group was more than t_0,higher than in the observation group(P < 0.05).The amount of blood loss in the observation group was lower than that of the control group(P < 0.05).The input of PRBCs in the control group was higher than that in the observation group(P < 0.05).The values of Hb% and Htc in the observation group were higher than those of the control group(P < 0.05).The usage and adverse reaction to propofol,fentanyl and rocuronium in the observation group were less than those in the control group(P < 0.05).The extubation time and the awakening time of the observation group were significantly longer than those of the control group(P < 0.05).Conclusion:Dexmedetomidine hydrochloride applied in the operation of multiple fractures in department of orthopedics can reduce hemodynamic fluctuations during operation and lucid interval,reduce the amount of intraoperative blood loss,postoperative blood transfusion volume,dosage of narcotic drugs,and adverse reactions during anesthesia.

关键词(KeyWords)： 骨折,多发性;盐酸右美托咪定;血流动力学;影响;麻醉诱导
fracture,multiple;dexmedetomidine hydrochloride;hemodynamic;influence;anesthesia induction

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 于国军,陈文超,袁哲
YU Guojun,CHEN Wenchao,YUAN Zhe

DOI: 10.19367/j.cnki.1000-2707.2018.02.025

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