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Received:August 01, 2019 Published Online:March 20, 2020
Received:August 01, 2019 Published Online:March 20, 2020
中文摘要: 目的 探讨右美托咪定对腰后路减压植骨融合内固定术患者围术期肝肾功能的影响。方法 选取2018年1月至2019年1月期间行腰后路减压植骨融合内固定术的患者98例,按随机数表法分为研究组和对照组(各49例)。在麻醉诱导前分别予以0.5~1.0 μg/kg右美托咪定和等容量生理盐水于10 min内输完。手术过程中研究组泵入右美托咪定,并以0.5~1.0 μg·kg-1·h-1持续输注至手术结束前20 min,对照组则泵入等容量生理盐水至手术结束前20 min。观察记录两组患者的术中情况,测定出两组患者麻醉诱导前30 min(T0)、手术结束时(T1)、手术结束后2 d(T2)的肝肾功能相关指标水平,包括血清胱抑素 C(CysC)、肌酐(Cr)、尿素(URE-A)、谷丙转氨酶(ALT)、谷草转氨酶(AST),并作对比分析。结果 手术过程中研究组尿量明显高于对照组(P<0.05),研究组瑞芬太尼、丙泊酚使用量明显低于对照组(P<0.05),两组术中低血压发生率差异不明显(P<0.05);与T0相比,T1的pH值明显下降,而乳酸和血糖却明显上升(P<0.05)。T2时研究组的乳酸明显低于对照组(P<0.05);与T0 相比,T1 时两组 ALT、AST、CysC、Cr、UREA水平明显下降(P<0.05),且T1、T2时研究组的ALT、AST、CysC、Cr、UREA水平明显低于对照组(P<0.05)。结论 腰后路减压植骨融合内固定术患者使用右美托咪定可以降低术中应激反应,减少术中麻醉药物的使用剂量,对患者围手术期的肝肾功能具有保护作用。
中文关键词: 右美托咪定 腰后路减压植骨融合内固定术 肝肾功能 瑞芬太尼 丙泊酚
Abstract:Objective To investigate the effect of dexmedetomidine on perioperative liver and kidney function in patients undergoing posterior lumbar decompression, bone grafting and internal fixation. Methods A total of 98 patients undergoing posterior lumbar decompression with bone grafting and fusion and internal fixation from January 2018 to January 2019 were divided into study group and control group (n=49, each). Before induction of anesthesia, 0.5-1.0 μg/kg dexmedetomidine and equal volume saline were infused in 10 minutes in two groups. During the operation, dexmedetomidine was pumped and continuously infused at 0.5-1.0 μg·kg-1·h-1 until to 20 minutes before the end of surgery in study group, while normal saline of equal volume was pumped and continuously infused in control group. At 30 minutes before anesthesia induction (T0), at the end of operation (T1) and 2 days after operation (T2), the levels of serum cystatin C (CysC), creatinine (Cr), urea, alanine aminotransferase (ALT) and asparate aminotransferase (AST) were measured and compared between two groups. Results During the operation, the urine volume in study group was significantly higher than that in control group (P<0.05), and the use of remifentanil and propofol was significantly lower than that in control group (P<0.05). There was no significant difference in the incidence of intraoperative hypotension between two groups (P<0.05). Compared with T0, pH significantly decreased, while Lac and Glu significantly increased at T1 (P<0.05). At T2, the level of Lac in study group was significantly lower than that in control group (P<0.05). Compared with T0, the levels of ALT, AST, CysC, Cr and urea significantly decreased at T1 in both groups(P<0.05). At T1 and T2, the levels of ALT, AST, CysC, Cr and urea in study group were significantly lower than those in control group (P<0.05). Conclusion For the patients undergoing posterior lumbar decompression, bone grafting and internal fixation, dexmedetomidine can reduce the intraoperative stress response and the dosage of anesthetics and has a protective effect on the liver and kidney function of patients during perioperative period.
keywords: Dexmedetomidine Posterior lumbar decompression, bone grafting, fusion and internal fixation Liver and kidney function Remifentanil Propofol
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基金项目:云南省教育厅科学研究基金(2016ZDX074)
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