[1]张新建,王晖玥,刘湘钰,等.右美托咪啶对行髋关节置换术老年高血压患者血压和心率的影响[J].新乡医学院学报,2020,37(1):048-51.[doi:10.7683/xxyxyxb.2020.01.012]
　ZHANG Xinjian,WANG Huiyue,LIU Xiangyu,et al.Effect of dexmedetomidine on blood pressure and heart rate in elderly patients with hypertension undergoing hip replacement[J].Journal of Xinxiang Medical University,2020,37(1):048-51.[doi:10.7683/xxyxyxb.2020.01.012]
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右美托咪啶对行髋关节置换术老年高血压患者血压和心率的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年1
页码:
048-51
栏目:
临床研究
出版日期:
2020-01-05

文章信息/Info

Title:
Effect of dexmedetomidine on blood pressure and heart rate in elderly patients with hypertension undergoing hip replacement
作者:
张新建; 王晖玥; 刘湘钰; 叶丽妮; 冯康平; 张春艳; 胡相萍
（广州中医药大学第三附属医院麻醉科，广东　广州　510378）
Author(s):
ZHANG Xinjian; WANG Huiyue; LIU Xiangyu; YE Lini; FENG Kangping; ZHANG Chunyan; HU Xiangping
(Department of Anesthesiology，the Third Affiliated Hospital of Guangzhou University of Chinese Medicine，Guangzhou 510378，Guangdong Province，China)
关键词:
右美托咪啶; 高血压; 老年人; 髋关节置换术
Keywords:
dexmedetomidine; hypertension; the elderly; hip replacement
分类号:
R971+2；R544.1
DOI:
10.7683/xxyxyxb.2020.01.012
文献标志码:
A
摘要:
目的　探讨右美托咪啶（DEX）对行髋关节置换术老年高血压患者血压和心率的影响。方法　选择2016年9月至2018年12月于广州中医药大学第三附属医院择期行髋关节置换术的150例老年患者为研究对象，美国麻醉学家学会分级Ⅰ～Ⅲ级，根据血压情况将患者分为正常血压组（C组）、1级高血压组（H1组）、2级高血压组（H2组）、3级高血压组（H3组）、单纯收缩期高血压（ISH）组，每组30例；5组患者均采用腰硬联合阻滞（L3～4），蛛网膜下腔缓慢注入5 g·L-1盐酸罗哌卡因注射液8～12 mg，阻滞平面控制在T10以下，麻醉后静脉泵注DEX负荷剂量0.5 μg·kg-1，泵注10 min，继以0.4 μg·kg-1·h-1泵注维持，于手术结束时停药。记录各组患者麻醉时间、术中出血量及术中输液量；观察麻醉开始前（T1）、使用DEX前（T2）及使用DEX后10 min（T3）、30 min（T4）、60 min（T5）患者的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）及降低幅值（T2~T5）。结果　5组患者麻醉时间、术中出血量及输液量比较差异均无统计学意义（P>0.05）。各组患者T2时SBP、DBP、MAP、HR与T1时比较差异均无统计学意义（P>0.05）；H1组、H2组、H3组和ISH组患者T3、T4、T5时SBP、DBP、MAP、HR低于T1时（P<0.05）；C组患者T3、T4、T5时MAP、HR低于T1时，T4、T5时SBP、DBP低于T1时（P<0.05）。H1组、H2组、H3组和ISH组患者各时间点SBP、DBP、MAP、HR高于C组（P<0.05）；T2与T5时，H1组、H2组、H3组和ISH组患者SBP、DBP、MAP及HR的差值大于C组（P<0.05），H3组患者SBP、DBP、MAP及HR的差值大于H1组、H2组和ISH组（P<0.05）。结论　DEX对不同高血压分级的老年患者有降低血压、减慢心率作用，有利于维持高血压患者血流动力学稳定；DEX对高血压3级患者影响较大，应用时要注意适当调整剂量。
Abstract:
Objective　To investigate the effect of dexmedetomidine (DEX) on the blood pressure and heart rate in elderly patients with hypertension undergoing hip replacement.Methods　A total of 150 elderly patients who underwent elective hip replacement in the Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from September 2016 to December 2018 were selected as the research subjects (America society of anesthesiologists grade Ⅰ-Ⅲ).The patients were divided into normal blood pressure group (group C)，grade 1 hypertension group (group H1)，grade 2 hypertension group (group H2)，grade 3 hypertension group (group H3) and isolated systolic hypertension (ISH) group according to the blood pressure，30 cases in each group.All patients in the five groups were carried out combined spinal and epidural anesthesia (L3-4).5 g·L-1 ropivacaine hydrochloride injection 8-12 mg was slowly injected into the subarachnoid space，and the block level was controlled below T10.After anesthesia，the loading dose of 0.5 μg·kg-1 DEX was injected intravenously for 10 minutes，then maintained by 0.4 μg·kg-1 DEX to the end of operation.The anesthesia time，intraoperative bleeding volume and intraoperative infusion volume were recorded.The systolic blood pressure (SBP)，diastolic blood pressure (DBP)，mean arterial pressure (MAP)，heart rate (HR) and the decrease value (T2－T5) of them were observed at the time points of before anesthesia (T1)，before DEX (T2) and 10 min (T3)，30 min (T4)，60 min (T5) after DEX.Results　There was no significant difference in anesthesia time，intraoperative bleeding volume and infusion volume among the five groups (P>0.05).There was no significant difference in SBP，DBP，MAP and HR between T1 and T2 in each group(P>0.05).The SBP，DBP，MAP and HR of patients at T3，T4 and T5 were lower than those at T1 in the H1 group，H2 group，H3 group and ISH group (P<0.05).In C group，the MAP and HR at T3，T4 and T5 were lower than those at T1，the SBP and DBP at T4 and T5 were lower than those at T1 (P<0.05).The SBP，DBP，MAP and HR of patients in H1 group，H2 group，H3 group and ISH group were higher than those in C group at every time points (P<0.05).At T2 and T5，the differences of SBP，DBP，MAP and HR in H1 group，H2 group，H3 group and ISH group were more than those in C group (P<0.05)，and the difference of SBP，DBP，MAP and HR in H3 group were more than those in H1 group，H2 group and ISH group (P<0.05).Conclusions　DEX can reduce blood pressure and slow heart rate in elderly patients with different hypertension grades，which is beneficial to maintain hemodynamic stability in patients with hypertension.DEX has a great influence on the patients with grade 3 hypertension，so the dosage should be adjusted properly.

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更新日期/Last Update: 2020-01-05