摘要
目的探讨不同剂量右美托咪定(DEX)泵注对老年髋关节置换术患者肾功能的影响。方法选择2014年3月～2017年6月于我院行髋关节置换术的老年患者188例,随机分成A组(n=47)、B组(n=47)、C组(n=47)和对照组(n=47),四组均予腰-硬联合阻滞麻醉。使用0.9%的氯化钠注射液配置4μg/mL的DEX。A组、B组、C组于醉诱导时0.4μg/kg剂量静脉泵注10min后,术中分别以0.5、1、1.5μg/kg持续至术毕。对照组泵注生理盐水。对不同剂量DEX泵注对老年髋关节置换术患者肾功能的影响对比分析。结果 (1)各组不同剂量用药下的镇静情况比较,呼吸变化、心率变化、收缩压变化差值比较,差异有统计学意义(P <0.05);(2)相比较A组,B组在术后2h、24h以及48h血浆NGAL水平明显更低(t_(2h)=11.214,P=0.001)、(t_(24h)=10.115,P=0.001)、(t_(48h)=9.347,P=0.001);相比较A组,对照组在术后2h、24h以及48h血浆NGAL水平明显更低(t_(2h)=9.847,P=0.001)、(t_(24h)=14.149,P=0.001)、(t_(48h)=12.341,P=0.001)。(3)相比较术前,A组术后2h及24h的Scr水平明显更低(t_(2h)=14.397,P=0.001)、(t_(2h)=11.103,P=0.001),但是48h的Scr水平无差异(t_(48h)=1.103,P=0.097);相比较术前,B组术后2h及24h的Scr水平明显更低(t_(2h)=11.114,P=0.001)、(t_(24h)=10.367,P=0.001),但是48h的Scr水平无差异(t_(48h)=1.574,P=0.093);相比较术前,C组术后2h及24h的Scr水平明显更低(t_(2h)=12.347,P=0.001)、(t_(24h)=9.689,P=0.001),但是48h的Scr水平比较,差异无统计学意义(t_(48h)=0.397,P=1.134)。结论针对老年髋关节置换术患者而言,采取不同右美托咪定麻醉,镇静效果存在差异,且对患者肾功能的存在一定影响,需要考虑剂量依赖性,选择恰当的剂量使用。
Objective To explore the effects of different doses of dexmedetomidine(DEX)pumping on renal functionsof elderly patients undergoing hip replacement.Methods 188 patients who underwenthip replacement in our hospital from March 2014 to June 2017 were selected and they were randomly divided into group A(n=47),group B(n=47),group C(n=47)and the control group(n=47).All 4 groups were givencombined lumbar-extradural anesthesia.DEX was prepared at 4 micg/mL using 0.9%sodium chloride injection.Group A,group B,and group C were intravenously pumped for 10 minutes at the dose of O.4ug/kg at the time ofanesthesia induction,and continued at 0.5,1,1.5μg/kg to the end of surgery.The control group was pumped with normal saline.The effects of different doses of dexmedetomidine(DEX)pumping on renal function of elderly patients undergoing hip replacement were compared and analyzed.Results(1)There were significant differences in the changes of respiration,heart rate and systolic blood pressure in different dosesbetween the four groups,which were statistically significant(P<0.05).(2)Compared with group A,plasma NGAL levels of 2h,24h and 48h after surgery were significantly lower in group B(t2h=11.214,P=0.001),(t24h=10.115,P=0.001),(t48h=9.347,P=0.001).Compared with group A,the plasma NGAL levels of 2h,24h and 48h after surgery were significantly lower inthe control group(t2h=9.847,P=0.001),(t24h=14.149,P=0.001),(t48h=12.341,P=0.001).(3)The Scr levels of 2h and 24h after surgeryin group A were significantly lower than those before surgery(t2h=14.397,P=0.001),(t2h=11.103,P=0.001),but there was no difference in Scr level at 48h(t48h=1.103,P=0.097).The Scr levels of 2h and 24h after surgeryin group B were significantly lower than those before surgery(t2h=11.114,P=0.001),(t24h=10.367,P=0.001),but there was no difference in Scr level at 48h(t48h=1.574,P=0.093).The Scr levels of 2h and 24h after surgery in group C were significantly lower than those before surgery(t2h=12.347,P=0.001),(t24h=9.689,P=0.001),but there was no difference in Scr level at 48h(t48h=0.397,P=1.134).Conclusion For the elderly patients undergoing hip replacement,different doses of dexmedetomidine for anesthesia has different sedative effectand it has a certain effecton the renal function of patients,so dose dependence should be considered and appropriate dose should be selected.
作者
林水华
何健超
庄县建
张俊文
LIN Shuihua;HE Jianchao;ZHUANG Xianjian;ZHANG Junwen(Department of Anesthesiology,Shaoguan Railway Hospital,Shaoguan 512023,China;Department of Anesthesiology,Enping People’s Hospital,Enping 529400,China)
出处
《中国医药科学》
2018年第23期102-104,125,共4页
China Medicine And Pharmacy
