The effect of dexmedetomidine combined with nicardipine on the controlled hypotension and inflammatory factors in elderly patients undergoing spinal surgery

doi:10.3877/cma.j.issn.2096-0263.2021.01.004

Abstract

Abstract:

Objective

To discuss the effect of dexmedetomidine combined with nicardipine on the controlled hypotension and inflammatory factors in elderly patients undergoing spinal surgery.

Methods

100 elderly patients undergoing spinal surgery (ASA physical status Ⅰ-Ⅱ) in our hospital from June 2017 to June 2019 were selected, there were 56 males and 44 females with an age of (70±6) years, and they divided into dexmedetomidine combined with nicardipine group (D+N group) and nicardipine group (N group), 50 cases in each group. The heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP) at 10 minutes before anesthesia (T₁), 10 minutes after operation (T₂), 20 minutes after operation (T₃), 30 minutes after operation (T₄), drug withdrawal (T₅), and at the end of operation (T₆) and the inflammatory factors such as interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein (CRP) at before operation and 2h, 6h after operation and operative field definition, intraoperative blood loss, adverse reactions were recorded.

Results

The HR[(78.5±5.8) times/min, (80.3±5.7) times/min, (81.6±5.9) times/min, (81.8±6.12) times/min, (80.1±8.6) times/min], MAP[(58.2±3.3)mmHg, (58.8±3.5)mmHg, (59.1±3.5)mmHg, (84.1±6.6) mm Hg, (83.1±6.2)mm Hg] and CVP[(4.0±0.5)cm H₂O, (4.1±0.5)cm H₂O, (4.2±0.5)cm H₂O, (5.2±0.5)cm H₂O, (5.1±0.5)cm H₂O] in the D+N group at T₂, T₃, T₄, T₅, T₆ were significantly lower than those in the N group[(85.6±6.5) times/min, (88.1±6.7) times/min, (89.3±6.9) times/min, (88.7±6.57) times/min, (86.4±6.4) times/min, (62.2±3.5)mm Hg, (63.3±3.5)mm Hg, (63.6±3.8)mm Hg, (92.6±6.4)mm Hg, (90.2±6.2)mm Hg, (4.7±0.5)cm H₂O, (4.9±0.5)cm H₂O, (5.0±0.5)cm H₂O, (7.1±0.7)cm H₂O, (6.6±0.7)cm H₂O], the difference was statistically significant (F=58.462, F=72.428, F=76.921; F=167.562, F=204.382, F=257.691; all P<0.05). The operative field definition score (2.1±0.3), intraoperative blood loss [(392±71)ml] in the D+N group were significantly lower than those in the N group [2.6±0.3, (684±95)ml], the difference was statistically significant (t=8.333, t=17.331, P<0.05). The levels of IL-6[(182.5±20.3)pg/ml, (253.6±30.2)pg/ml], TNF-alpha[(35.7±4.0)ng/ml, (44.4±5.7)ng/ml] and CRP[(27.2±2.2)mg/L, (42.1±5.0)mg/L] in the D+N group at 2 and 6h after operation were significantly lower than those in the N group[(214.3±25.7)pg/ml, (342.4±36.1)pg/ml, (41.5±4.7)ng/ml, (56.4±6.2)ng/ml, (34.3±2.7)mg/L, (58.4±6.4)mg/L], the difference was statistically significant (F=64.871, F=82.653, F=93.254; F=94.268, F=125.436, F=151.367; F=74.216, F=90.843, F=98.630; P<0.05). The incidence of adverse reactions (10.0%) in the D+N group was significantly lower than that in the N group (30.0%), the difference was statistically significant (χ²=6.250, P<0.05).

Conclusions

Dexmedetomidine combined with nicardipine can effectively improve the controlled hypotensive effect of elderly patients undergoing spinal surgery, it is helpful to improve the hemodynamics and operative field definition of patients, and it can reduce the inflammatory stress reaction and adverse reactions after surgery, it’s worth for further clinical promotion.

Key words: Dexmedetomidine, Nicardipine, Spinal surgery, Hypotension, Inflammatory

Li Ma, Mei Wang. The effect of dexmedetomidine combined with nicardipine on the controlled hypotension and inflammatory factors in elderly patients undergoing spinal surgery[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2021, 07(01): 15-21.

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References 20

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组别	例数	性别（例，男/女）	术式（例，骨折修复/间盘突出）	手术节段（例，L_2~3/L_4~5/T₁₁/T₁₂）	平均年龄（岁，±s）	体质量指数（kg/m²，±s）	手术时间（min，±s）
N组	50	26/24	22/28	6/14/18/12	69±6	22.3±2.1	117±19
D+N组	50	30/20	18/32	4/16/20/10	70±6	22.1±2.0	119±19
χ²/t值		0.649	0.667	0.820	0.975	0.611	0.447
P值		0.420	0.414	0.365	0.332	0.542	0.656

组别	例数	性别（例，男/女）	术式（例，骨折修复/间盘突出）	手术节段（例，L_2~3/L_4~5/T₁₁/T₁₂）	平均年龄（岁，±s）	体质量指数（kg/m²，±s）	手术时间（min，±s）
N组	50	26/24	22/28	6/14/18/12	69±6	22.3±2.1	117±19
D+N组	50	30/20	18/32	4/16/20/10	70±6	22.1±2.0	119±19
χ²/t值		0.649	0.667	0.820	0.975	0.611	0.447
P值		0.420	0.414	0.365	0.332	0.542	0.656

组别	例数	HR（次/min）
组别	例数	T₁	T₂	T₃	T₄	T₅	T₆	F值	P值
N组	50	82.4±6.1	85.6±6.5^*	88.1±6.7^*	89.3±6.9^*	88.7±6.57^*	86.4±6.4^*	58.462	<0.001
D+N组	50	82.9±6.3	78.5±5.8^*	80.3±5.7	81.6±5.9	81.8±6.12	80.1±8.6
F值		0.628	6.258	6.854	7.263	7.564	6.514
P值		0.428	<0.001	<0.001	<0.001	<0.001	<0.001
组别	例数	MAP（mm Hg）
组别	例数	T₁	T₂	T₃	T₄	T₅	T₆	F值	P值
N组	50	85.7±6.5	62.2±3.5^*	63.3±3.5^*	63.6±3.8^*	92.6±6.4^*	90.2±6.2^*	72.428	<0.001
D+N组	50	86.3±6.6	58.2±3.3^*	58.8±3.5^*	59.1±3.5^*	84.1±6.6^*	83.1±6.2^*
F值		0.824	6.368	6.952	6.711	9.684	8.752
P值		0.306	<0.001	<0.001	<0.001	<0.001	<0.001
组别	例数	CVP（cm H₂O）
组别	例数	T₁	T₂	T₃	T₄	T₅	T₆	F值	P值
N组	50	5.6±0.6	4.7±0.5^*	4.9±0.5^*	5.0±0.5^*	7.1±0.7^*	6.6±0.7^*	76.921	<0.001
D+N组	50	5.7±0.6	4.0±0.5^*	4.1±0.5^*	4.2±0.5^*	5.2±0.5^*	5.1±0.5^*
F值		1.067	7.865	8.365	8.526	12.976	10.862
P值		0.211	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	HR（次/min）
组别	例数	T₁	T₂	T₃	T₄	T₅	T₆	F值	P值
N组	50	82.4±6.1	85.6±6.5^*	88.1±6.7^*	89.3±6.9^*	88.7±6.57^*	86.4±6.4^*	58.462	<0.001
D+N组	50	82.9±6.3	78.5±5.8^*	80.3±5.7	81.6±5.9	81.8±6.12	80.1±8.6
F值		0.628	6.258	6.854	7.263	7.564	6.514
P值		0.428	<0.001	<0.001	<0.001	<0.001	<0.001
组别	例数	MAP（mm Hg）
组别	例数	T₁	T₂	T₃	T₄	T₅	T₆	F值	P值
N组	50	85.7±6.5	62.2±3.5^*	63.3±3.5^*	63.6±3.8^*	92.6±6.4^*	90.2±6.2^*	72.428	<0.001
D+N组	50	86.3±6.6	58.2±3.3^*	58.8±3.5^*	59.1±3.5^*	84.1±6.6^*	83.1±6.2^*
F值		0.824	6.368	6.952	6.711	9.684	8.752
P值		0.306	<0.001	<0.001	<0.001	<0.001	<0.001
组别	例数	CVP（cm H₂O）
组别	例数	T₁	T₂	T₃	T₄	T₅	T₆	F值	P值
N组	50	5.6±0.6	4.7±0.5^*	4.9±0.5^*	5.0±0.5^*	7.1±0.7^*	6.6±0.7^*	76.921	<0.001
D+N组	50	5.7±0.6	4.0±0.5^*	4.1±0.5^*	4.2±0.5^*	5.2±0.5^*	5.1±0.5^*
F值		1.067	7.865	8.365	8.526	12.976	10.862
P值		0.211	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	术野清晰度评分[例（%）]						术中失血量（ml，±s）
组别	例数	1分	2分	3分	4分	5分	均值	术中失血量（ml，±s）
D+N组	50	22（44.0）	14（28.0）	8（16.0）	8（16.0）	0（0.0）	2.1±0.3	392±71
N组	50	10（20.0）	16（32.0）	10（20.0）	11（22.0）	3（6.0）	2.6±0.3	684±95
χ²/t值		6.618	0.190	0.271	0.585	3.093	8.333	17.331
P值		0.010	0.663	0.603	0.444	0.079	<0.001	<0.001

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