CAJ | 학술논문

目的研究盐酸右美托咪定用于控制性降压患者的安全性、可行性和对患者脑氧代谢、术后认知功能的影响.方法选择全麻下行脊柱手术的患者60例,随机分为D组N组,每组30例.两组麻醉方法相同,D组予盐酸右美托咪负荷剂量0.5 μg/kg静注(5 min)后以0.2～0.7μg/(kg·h)速度泵注维持;N组以硝酸甘油2μg/kg缓慢静注,以3～6μg/(kg·min)维持,目标使MAP较术前基础值下降30%,降压时间为70分钟.监测并记录各组T0～T6时点的MAP、HR、ECG、BIS、SEVO%.在T0、T6时刻血气分析计算CaO2、CjvO2、CERO2.记录术前、术后MMSE评分.结果 D组在T2～T5期间HR波动于(55.7±6.4)至(65.73.4±5.2)bpm,与对应时间点N组的(76.5±7.7)至(85.5±8.2)bpm明显下降(P＜0.05),D组MAP在T1、T6分别为(85.8±5.7)、(80.5±7.9)mmHg,与相应N组的(77.4±6.7)、(91.3±8.2)mmHg比较差异有显著性(P＜0.05);两组患者T0、T6时点CERO2及MMSE评分差异无显著性(P＞0.05).结论盐酸右美托咪定控制性降压是安全可行的;对脑氧代谢及术后认知功能无明显影响.
목적 연구염산우미탁미정용우공제성강압환자적안전성、가행성화대환자뇌양대사、술후인지공능적영향.방법 선택전마하행척주수술적환자60례,수궤분위D조N조,매조30례.량조마취방법 상동,D조여염산우미탁미부하제량0.5 μg/kg정주(5 min)후이0.2～0.7μg/(kg·h)속도빙주유지;N조이초산감유2μg/kg완만정주,이3～6μg/(kg·min)유지,목표사MAP교술전기출치하강30%,강압시간위70분종.감측병기록각조T0～T6시점적MAP、HR、ECG、BIS、SEVO%.재T0、T6시각혈기분석계산CaO2、CjvO2、CERO2.기록술전、술후MMSE평분.결과 D조재T2～T5기간HR파동우(55.7±6.4)지(65.73.4±5.2)bpm,여대응시간점N조적(76.5±7.7)지(85.5±8.2)bpm명현하강(P＜0.05),D조MAP재T1、T6분별위(85.8±5.7)、(80.5±7.9)mmHg,여상응N조적(77.4±6.7)、(91.3±8.2)mmHg비교차이유현저성(P＜0.05);량조환자T0、T6시점CERO2급MMSE평분차이무현저성(P＞0.05).결론 염산우미탁미정공제성강압시안전가행적;대뇌양대사급술후인지공능무명현영향.
Objective To investigate the safety and feasibility of deliberate hypotension with dexmedetomidine hydrochloride ,as well as the effects on cerebral oxygen metabolism and postoperative cognitive function. Methods Sixty patients who underwent posterior lumbar interbody fusion were randomly divided into group D and group N,30 in each group. Both groups were anesthetized with same methods. In group D, intravenous administration of dexmedetomidine hydrochloride 0.5μg/kg followed by reduce the MAP to 30%, which was maintained for 70 minutes. Record MAP, HR,ECG,BIS,SEVO%,and arterial blood samples and jugular blood samples were taken synchronously for measuring blood gas,MMSE were recorded before and after operation .Reaulta Compared with N group,heart rate of D group decreased significantly from time T2 to T5 (P＜0.05), the mean arterial pressure in group D was increased at T5 and increased at T6(P＜0.05). The level of CERO2 and MMSE showed no significant change(P＞0.05).C onclusions The patients of deliberate hypotension with dexmedetomidine hydrochloride was safe and feasible. It had no effect on the cerebral oxygen metabolism and postoperative cognitive function.