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目的 观察右美托咪定复合尼卡地平应用于脊柱手术中控制性降压的效果.方法 将40 例择期全身麻醉腰椎手术患者随机分为尼卡地平组(N组)和右美托咪定复合尼卡地平组(YN组)各20 例,观察麻醉前(T0),降压后15 min (T1)、降压后30 min(T2)、降压后45 min(T3),以及拔管后1 min(T4)的平均动脉压(MAP)、心率(HR),并计算出相应的心率收缩压乘积(RPP),以及血乳酸值(Lac)、血清皮质醇水平,记录手术补液量、出血量、手术视野满意度、MAP的恢复时间.结果 降压后与T0时刻比较:两组T1-T3时点MAP明显下降(P＜0.05);N组T1-T4时点HR明显升高(P＜0.05),YN组T1-T3时点HR明显减慢(P＜0.05);N组T1-T3时点RPP无明显变化(P＞0.05),YN组T1-T3时点RPP明显下降(P＜0.05);两组Lac水平T2-T4时点明显上升(P＜0.05);两组血清皮质醇T1-T4时点明显上升(P＜0.05).与N组比较:T1-T4时点,YN组HR明显下降(P＜0.05),RPP明显下降(P＜0.05),血清皮质醇明显下降(P＜0.05);且T2-T4时点,YN组Lac水平明显下降(P＜0.05);同时YN组手术补液量、出血量均减少(P＜0.05),手术视野清晰度评分、达到目标血压所需时长明显低于N组(P＜0.05).结论 在脊柱手术中,右美托咪定复合尼卡地平能够有效控制患者的MAP和HR,维持血流动力学的稳定,有效降低患者心脏风险和应激反应,术中出血量更少,术野质量更佳,具有较高的临床价值,值得应用推广.“,”Objective To evaluate the clinical effect of dexmedetomidine combined with nicardipine on controlled hypotension of lumbar surgery. Methods 40 hospitalized patients with upcoming lumbar surgery were randomly distributed into 2 groups: nicardipine group (group N, n＝20) and dexmedetomidine combined with nicardipine group (group YN, n＝20). The MAP, HR, RPP, the blood lactic acid value (Lac), and the serum cortisol levels were monitored and calculated at the following time points: before anesthesia induction (T0), 15 min (T1), 30 min (T2), 45 min (T3) after controlled hypotension and 1 min after extubation (T4). Meanwhile the volume of operative fluid replacement, intraoperative blood loss, the surgical field quality score and MAP recovery time were recorded respectively. Results Compared with the parameters at T0, the MAP of T1-T3in both groups decreased significantly (P＜0.05); the HR of T1-T4in group N increased significantly (P＜0.05); the HR of T1-T3 in group YN slowed down significantly (P＜0.05); there was no significant difference at T1-T3of RPP in group N (P > 0.05), but RPP decreased at T1-T3in group YN (P＜0.05); the value of Lac at T2-T4in both groups increased significantly (P＜0.05); the serum cortisol levels at T1-T4in both groups increased significantly. Compared with group N, the HR of T1-T4in group YN was lower (P＜0.05), and RPP was also lower at T1-T4in group YN (P＜0.05); the value of Lac of T2-T4in group YN was lower (P＜0.05); the serum cortiso levels of T1-T4in group YN was lower (P＜0.05); the volume of operative fluid replacement, the intraoperative blood loss, as well as the surgical field quality score of group YN decreased significantly (P＜0.05); and the MAP recovery time of group YN was shorter (P＜0.05). Conclusion The combination of dexmedetomidine and nicardipine has prominent effect on controlled hypotension, which can stabilize hemodynamics, provide good antihypertensive effect and operative field, also it can reduce blood loss in patients undergoing lumbar surgery.