低浓度肾上腺素对减少全髋关节置换术中骨水泥植入综合征的影响

摘要

目的:探讨低浓度肾上腺素生理盐水混合液(1∶500 000)髓腔冲洗填塞法对全髋关节置换术(total hip replacement,THR)过程中生命体征及骨水泥植入综合征(bone cement implantation syndrome, BCIS)的影响.方法:将1 52名拟行THR的患者随机分为观察组(76例)和对照组(76例),其中对照组使用生理盐水冲洗及纱布填塞骨髓腔,观察组使用低浓度肾上腺素生理盐水混合液冲洗及纱布填塞骨髓腔,收集并比较两组患者在髓腔冲洗填塞后(T0)、骨水泥注入时(T1)与注入后5 min(T2)、10 min(T3)的生命体征变化情况及BCIS的发生率.结果:观察组在T1,T2的心率、收缩压、指尖血氧饱和度均明显高于对照组(P＜0.05),重复测量方差分析结果显示,两组在不同时间点的心率、收缩压、指尖血氧饱和度的组内效应、时间效应、交互效应均具有统计学意义(P＜0.05),在舒张压及中心静脉压的时间效应具有统计学意义(P＜0.001);观察组在呼吸窘迫、低氧血症和低血压性休克的发生率明显明显低于对照组(P＜0.05).结论:低浓度肾上腺素髓腔冲洗填塞法有利于维持患者在骨水泥植入过程中的生命体征稳定,减少BCIS的发生,对于确保THR患者的手术安全具有积极的促进作用.%Objective:To discuss the influence of medullary cavity washing and filling with mixed liquor of low-concentration epinephrine and normal saline (NS) (1:500 000) on vital signs and bone cement implantation syndrome (BCIS) in the process of total hip replacement (THR).Methods:One hundred and fifty-two patients intending to have THR were divided into an observation group (76 patients) and a control group (76 patients) randomly.The control group adopted NS for washing and gauze for filling the marrow cavity,while the observation group adopted the mixed liquor of low-concentration epinephrine and NS for washing and adopted gauze for filling the marrow cavity.The changes of vital signs and BCIS occurrence rate of the patients of two groups occurring after medullary cavity washing and filling (To),during bone cement filling (T1),5 min after filling (T2) and 10 min after filling (T3) were collected and compared.Results:The heart rate,systolic pressure,fingertip blood oxygen saturation degree of patients of the observation group at T1 and T2 were evidently higher than those of the control group (P＜0.05).As indicated by the repeated measuring variance analysis results,the inter-group effect,time effect and interaction effect of heart rate,systolic pressure,fingertip blood oxygen saturation degree of the two groups at different time points were of statistical significance (P＜0.05);the time effect of diastolic pressure and central venous pressure was of statistical significance (P＜0.001).The occurrence rates of respiratory distress,hypoxia and hypotension shock of the observation group were evidently lower than those of the control group (P＜0.05).Conclusion:The medullary cavity washing and filling with low-concentration epinephrine helps maintain stable vital signs of the patients in bone cement implantation and reduce the occurrence rate of BCIS.The method can positively enhance the operation safety of THR patients.