摘要
目的比较麻黄碱与甲氧明对稳定老年下肢骨科手术松止血带后患者心率(HR)和血压的应用价值.方法选择行单侧下肢手术且术中使用止血带的老年患者450例作为研究对象,随机分为对照组、麻黄碱组和甲氧明组,每组150例.在松止血带同时,对照组注射生理盐水1 mL,麻黄碱组注射麻黄碱10 mg(1 mL),甲氧明组注射甲氧明2 mg(1 mL).比较3组患者在松止血带前(T 0)、松止血带后即刻(T 1)、1 min(T 2)、3 min(T 3)、5 min(T 4)、10 m in(T 5)时的HR和血压情况,并观察并发症的发生情况.结果与同组T 0时比较,对照组在T 1、T 2、T 3、T 4时,麻黄碱组在T 2、T 3时HR均明显升高,差异具有统计学意义(P<0.05),在T 1、T 2时HR波动最为明显;与对照组比较,麻黄碱组和甲氧明组在T 1、T 2、T 3、T 4时HR均明显降低,差异具有统计学意义(P<0.05);与麻黄碱组比较,甲氧明组在T 1、T 2、T 3、T 4时HR均明显降低,差异具有统计学意义(P<0.05).与同组T 0时比较,3组患者在松止血带后各时刻收缩压和舒张压均明显下降,差异具有统计学意义(P<0.05),在T 1和T 2时血压波动最为明显,其后逐渐恢复稳定;与对照组比较,麻黄碱组和甲氧明组在T 1、T 2、T 3时收缩压和舒张压均更高,下降幅度均小于对照组,差异具有统计学意义(P<0.05);麻黄碱组和甲氧明组观察指标比较差异均无统计学意义(P>0.05).对照组并发症的总发生率为14.0%,明显高于麻黄碱组(2.7%)和甲氧明组(2.0%),差异具有统计学意义(P<0.05).结论下肢骨科手术患者在松止血带时滴注麻黄碱或甲氧明有利于维持HR和血压稳定,减少并发症的发生.
Objective To compare the application value of ephedrine and methoxymin in stabilizing heart rate and blood pressure of elderly patients with lower extremity orthopedic operation and tourniquet.Method 450 elderly patients who underwent unilateral lower extremity surgery and used tourniquet during the operation were randomly divided into control group,ephedrine group and methoxyming group,150 cases each.At the same time of releasing tourniquet,the control group was injected with normal saline 1 mL,the ephedrine group was injected with ephedrine 10 mg(1 mL),and the methoxyming group was injected with methoxyming 2 mg(1 mL).The heart rate and blood pressure of the three groups before(T 0),immediately(T 1),1 min(T 2),3 min(T 3),5 min(T 4)and 10 min(T 5)after releasing tourniquet were compared,and the occurrence of complications such as restlessness,palpitation,chest distress,chills,hypotension and bradycardia were observed.Results Compared with the same group at T 0,the heart rate at T 1,T 2,T 3 and T 4 of the control group,and at T 2 and T 3 of the ephedrine group was significantly higher(P<0.05),and the fluctuation was most obvious at T 1 and T 2.Compared with the control group,the heart rate of ephedrine group and methoxyming group was significantly lower at T 1,T 2,T 3 and T 4(P<0.05);compared with ephedrine group,the heart rate of methoxyming group was significantly lower at T 1,T 2,T 3 and T 4(P<0.05).Compared with the same group at T 0,the systolic blood pressure and diastolic blood pressure of the three groups decreased significantly at each time point after tourniquet release(P<0.05).Compared with the control group,the systolic blood pressure and diastolic blood pressure of ephedrine group and methoxyming group were higher at T 1,T 2 and T 3,the decrease range was smaller than that of the control group(P<0.05);while there was no difference between the ephedrine group and methoxyming group(P>0.05).The complications incidence of the control group(14.0%)was significantly higher than that of ephedrine group(2.7%)and methoxyming group(2.0%)(P<0.05).Conclusion Intravenous ephedrine or methoxymin is helpful to maintain the stability of heart rate and blood pressure,and reduce the incidence of complications.
作者
周丽敏
陈军
陈娟娟
程晨
ZHOU Limin;CHEN Jun;CHEN Juanjuan;CHENG Chen(East Hospital,Sixth People’s Hospital,Shanghai Jiaotong University,Shanghai 201306,China)
出处
《北华大学学报（自然科学版）》
CAS
2020年第4期510-513,共4页
Journal of Beihua University（Natural Science）
基金
上海市健康医学院种子基金项目(HMSF-17-21-016)
上海交通大学附属第六人民医院东院院级科学研究基金项目(2015023).
关键词
下肢手术
麻黄碱
甲氧明
血压
心率
lower extremity orthopaedic surgery
ephedrine
methoxyphene
blood pressure
heart rate
作者简介
周丽敏(1988—),女,护师,主要从事麻醉学临床研究,E-mail:418025660@qq.com.
