盐酸甲氧明注射液持续泵注辅助静吸复合全身麻醉对高龄股骨颈骨折患者术中血流动力学及心脏做功的影响
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摘要
目的观察盐酸甲氧明注射液持续泵注辅助静吸复合全身麻醉对高龄股骨颈骨折患者术中血流动力学及心脏做功的影响。方法选取2017年2月～2018年2月西安市红会医院择期行髋关节置换术治疗的高龄股骨颈骨折患者82例,以随机数字表法分为对照组(n=41)与观察组(n=41)。两组均采取静吸复合全身麻醉,对照组在麻醉诱导前持续微量泵注生理盐水,观察组在麻醉诱导前持续微量泵注盐酸甲氧明注射液。比较两组麻醉诱导前5 min(T_0)、气管插管即刻(T_1)、气管插管后5 min(T_2)、气管插管后15 min(T_3)的血流动力学指标,包括平均动脉压(MAP)、心率(HR),及麻醉诱导完成后、术毕时心脏做功指标,包括左室每搏功(LVSW)、每搏指数(SVI),并比较两组不良反应发生情况。结果 T_0时两组MAP、HR差异无统计学意义(P> 0.05),观察组T_1、T_2、T_3时的MAP、HR与T_0时比较,差异无统计学意义(P> 0.05),观察组T_1、T_2、T_3时MAP高于对照组,HR低于对照组(P <0.05);观察组麻醉诱导完成后、术毕时LVSW、SVI均低于对照组(P <0.05);观察组不良反应发生率(9.76%)低于对照组(29.27%)(P <0.05)。结论对行髋关节置换术治疗的高龄股骨颈骨折患者采取盐酸甲氧明注射液持续泵注辅助静吸复合全身麻醉可稳定患者术中血流动力学情况,降低心脏做功,减少低血压、心动过速等不良反应的发生。
Objective To explore the effect of continuous sputum injection of Methoxamine Hydrochloride Injection assisted intravenous-inhalation combined with general anesthesia on intraoperative hemodynamics and stroke work in elderly patients with transcervical fracture. Methods From February 2017 to February 2018, 82 patients with transcervical fracture treated by hip arthroplasty in Xi′ an Red Conference Hospital were selected and divided into the control group(n = 41) and the observation group(n = 41) by the random number table method. Both groups were treated with intravenous-inhalation combined general anesthesia. The control group was given continuous infusion of normal saline before induction of anesthesia, and the observation group was given continuous pump injection of Methoxamine Hydrochloride Injection before induction of anesthesia. The hemodynamic parameters including mean arterial pressure(MAP), heart rate(HR) at the time of 5 min before anesthesia induction(T_0), endotracheal intubation(T_1) and 5 min(T_2)and 15 min(T_3) after trachea cannula, and the cardiac performance index including left ventricular beats(LVSW),stroke index(SVI) at the end of anesthesia induction and at the end of operation of two groups were compared. And the adverse reactions of two groups were compared. Results There was no significant difference between two groups in MAP and HR at T0(P > 0.05). There was no significant difference in MAP and HR at T_1, T_2 and T_3 compared with those at T_0 in the observation group(P > 0.05). The MAP at T_1, T_2 and T_3 of observation group was higher than that of control group, while HR was lower than that of control group(P < 0.05). The LVSW and SVI of the observation group were lower than those of the control group at the end of anesthesia induction and at the end of operation(P < 0.05). The incidence of adverse reactions in the observation group was 9.76%, lower than 29.27% in the control group(P < 0.05). Conclusion Continuous pump injection of Methoxamine Hydrochloride Injection assisted intravenous-inhalation combined general anesthesia in treating elderly patients with transcervical fracture can stabilize hemodynamics in patients and reduce cardiac work, reduce the occurrence of adverse reactions such as hypotension and tachycardia.
Objective To explore the effect of continuous sputum injection of Methoxamine Hydrochloride Injection assisted intravenous-inhalation combined with general anesthesia on intraoperative hemodynamics and stroke work in elderly patients with transcervical fracture. Methods From February 2017 to February 2018, 82 patients with transcervical fracture treated by hip arthroplasty in Xi′ an Red Conference Hospital were selected and divided into the control group(n = 41) and the observation group(n = 41) by the random number table method. Both groups were treated with intravenous-inhalation combined general anesthesia. The control group was given continuous infusion of normal saline before induction of anesthesia, and the observation group was given continuous pump injection of Methoxamine Hydrochloride Injection before induction of anesthesia. The hemodynamic parameters including mean arterial pressure(MAP), heart rate(HR) at the time of 5 min before anesthesia induction(T_0), endotracheal intubation(T_1) and 5 min(T_2)and 15 min(T_3) after trachea cannula, and the cardiac performance index including left ventricular beats(LVSW),stroke index(SVI) at the end of anesthesia induction and at the end of operation of two groups were compared. And the adverse reactions of two groups were compared. Results There was no significant difference between two groups in MAP and HR at T0(P > 0.05). There was no significant difference in MAP and HR at T_1, T_2 and T_3 compared with those at T_0 in the observation group(P > 0.05). The MAP at T_1, T_2 and T_3 of observation group was higher than that of control group, while HR was lower than that of control group(P < 0.05). The LVSW and SVI of the observation group were lower than those of the control group at the end of anesthesia induction and at the end of operation(P < 0.05). The incidence of adverse reactions in the observation group was 9.76%, lower than 29.27% in the control group(P < 0.05). Conclusion Continuous pump injection of Methoxamine Hydrochloride Injection assisted intravenous-inhalation combined general anesthesia in treating elderly patients with transcervical fracture can stabilize hemodynamics in patients and reduce cardiac work, reduce the occurrence of adverse reactions such as hypotension and tachycardia.
引文
[1]王本杰,赵德伟,谢辉,等.骨水泥型和生物型股骨假体半髋置换修复高龄股骨颈骨折[J].中国组织工程研究,2015,19(9):1345-1351.
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[7]佟明建,罗克金.盐酸甲氧明对腰硬联合麻醉下行膝关节置换术老年患者血流动力学的影响[J].临床和实验医学杂志,2016,15(21):2164-2166.
[8]郭正轩,胡张钊.甲氧明持续泵注对老年全髋关节置换术患者认知功能的影响[J].中国老年保健医学,2016,14(4):42-43.
[9]郝裕霞,赵晓玲.静脉预注甲氧明对全髋关节置换术中低血压的防治作用[J].实用医药杂志,2014,31(2):144-145.
[10]魏光武,宋米娜,张玲.持续泵注甲氧明在高龄患者全身麻醉诱导中的应用价值[J].医学综述,2016,22(12):2444-2446.
[11]左宪丽.高龄全髋关节置换术患者不同麻醉方法效果观察[J].河南外科学杂志,2017,23(4):121-122.
[12]赵达强,殳卓琳.高龄患者半髋关节置换手术麻醉的体会[J].老年医学与保健,2014,20(5):340-341.
[13]章明勇.甲氧明与麻黄碱预注射对老年患者肌松效果及生命体征的影响[J].中华全科医学,2015,13(1):148-149.
[14]杨刚,宋世姣,尹静,等.甲氧明防治老年患者下肢骨科手术蛛网膜下腔阻滞后低血压的临床研究[J].重庆医学,2015,44(17):2359-2361.
[15]Luo XJ,Zheng M,Tian G,et al.Comparison of the treatment effects of methoxamine and combining methoxamine with atropine infusion to maintain blood pressure during spinal anesthesia for cesarean delivery:a double blind randomized trial[J].Eur Rev Med Pharmacol Sci,2016,20(3):561.
[16]赵闯.甲氧明用于老年患者全身麻醉诱导中的价值分析[J].中国现代药物应用,2016,10(12):169-170.
[17]Sun S,Sun D,Yang L,et al.Dose-dependent effects of intravenous methoxamine infusion during hip-joint re placement surgery on postoperative cognitive dysfunction and blood TNF-αlevel in elderly patients:a randomized controlled trial[J].BMC Anesthesiol,2017,17(1):75.
[18]邹高锐,封享兰,范钧钊,等.氢化泼尼松与甲氧明对老年患者髋关节置换术中血流动力学的影响[J].山东医药,2017,57(37):81-84.
[19]吴爱玲,杨勇,华薇,等.甲氧明对全身麻醉下择期进行非心脏手术患者全诱导期生命体征的影响[J].中国临床药理学杂志,2017,33(13):1191-1193.
[20]关江,郭尔萍,常万琪.小剂量甲氧明在高血压患者全麻诱导期中的应用[J].中外医学研究,2018,16(14):13-16.
[21]佟明建,罗克金.盐酸甲氧明对腰硬联合麻醉下行膝关节置换术老年患者血流动力学的影响[J].临床和实验医学杂志,2016,15(21):2164-2166.
[22]张凌,万磊,丁冠男.甲氧明持续输注对全麻复合硬膜外麻醉下开胸肺叶切除术中血流动力学的影响[J].临床和实验医学杂志,2017,16(9):922-924.
[23]吴超.盐酸戊乙奎醚对老年心脏瓣膜置换术微循环的影响[J].实用老年医学,2014,28(12):1039-1042.
[2]赵杰青,朱曙,张西金.人工股骨头置换术治疗高龄股骨颈骨折[J].临床骨科杂志,2014,20(2):176-177.
[3]梁勇,高昌俊,高鹏.脊椎-硬膜外联合阻滞改良法用于高龄患者膝关节置换术的效果[J].中国医药导刊,2016,18(6):559-561.
[4]Soleimanha M,Sedighinejad A,Haghighi M,et al.Hemodynamic and arterial blood gas parameters during cemented hip hemiarthroplasty in elderly patients[J].Arch Bone Jt Surg,2014,2(3):163-167.
[5]吕进.盐酸甲氧明对高龄患者全麻诱导期间心脏做功、心肌损伤及氧化应激反应的影响[J].海南医学院学报,2017,23(22):3173-3175.
[6]赵艳丽,田丹丹.盐酸甲氧明和多巴胺对老年患者全麻诱导期间血流动力学及心脏泵功能的影响[J].广东医学,2016,37(10):1551-1555.
[7]佟明建,罗克金.盐酸甲氧明对腰硬联合麻醉下行膝关节置换术老年患者血流动力学的影响[J].临床和实验医学杂志,2016,15(21):2164-2166.
[8]郭正轩,胡张钊.甲氧明持续泵注对老年全髋关节置换术患者认知功能的影响[J].中国老年保健医学,2016,14(4):42-43.
[9]郝裕霞,赵晓玲.静脉预注甲氧明对全髋关节置换术中低血压的防治作用[J].实用医药杂志,2014,31(2):144-145.
[10]魏光武,宋米娜,张玲.持续泵注甲氧明在高龄患者全身麻醉诱导中的应用价值[J].医学综述,2016,22(12):2444-2446.
[11]左宪丽.高龄全髋关节置换术患者不同麻醉方法效果观察[J].河南外科学杂志,2017,23(4):121-122.
[12]赵达强,殳卓琳.高龄患者半髋关节置换手术麻醉的体会[J].老年医学与保健,2014,20(5):340-341.
[13]章明勇.甲氧明与麻黄碱预注射对老年患者肌松效果及生命体征的影响[J].中华全科医学,2015,13(1):148-149.
[14]杨刚,宋世姣,尹静,等.甲氧明防治老年患者下肢骨科手术蛛网膜下腔阻滞后低血压的临床研究[J].重庆医学,2015,44(17):2359-2361.
[15]Luo XJ,Zheng M,Tian G,et al.Comparison of the treatment effects of methoxamine and combining methoxamine with atropine infusion to maintain blood pressure during spinal anesthesia for cesarean delivery:a double blind randomized trial[J].Eur Rev Med Pharmacol Sci,2016,20(3):561.
[16]赵闯.甲氧明用于老年患者全身麻醉诱导中的价值分析[J].中国现代药物应用,2016,10(12):169-170.
[17]Sun S,Sun D,Yang L,et al.Dose-dependent effects of intravenous methoxamine infusion during hip-joint re placement surgery on postoperative cognitive dysfunction and blood TNF-αlevel in elderly patients:a randomized controlled trial[J].BMC Anesthesiol,2017,17(1):75.
[18]邹高锐,封享兰,范钧钊,等.氢化泼尼松与甲氧明对老年患者髋关节置换术中血流动力学的影响[J].山东医药,2017,57(37):81-84.
[19]吴爱玲,杨勇,华薇,等.甲氧明对全身麻醉下择期进行非心脏手术患者全诱导期生命体征的影响[J].中国临床药理学杂志,2017,33(13):1191-1193.
[20]关江,郭尔萍,常万琪.小剂量甲氧明在高血压患者全麻诱导期中的应用[J].中外医学研究,2018,16(14):13-16.
[21]佟明建,罗克金.盐酸甲氧明对腰硬联合麻醉下行膝关节置换术老年患者血流动力学的影响[J].临床和实验医学杂志,2016,15(21):2164-2166.
[22]张凌,万磊,丁冠男.甲氧明持续输注对全麻复合硬膜外麻醉下开胸肺叶切除术中血流动力学的影响[J].临床和实验医学杂志,2017,16(9):922-924.
[23]吴超.盐酸戊乙奎醚对老年心脏瓣膜置换术微循环的影响[J].实用老年医学,2014,28(12):1039-1042.