不同麻醉辅助用药复合腰麻对老年髋关节手术患者生命体征及舒适性比较  

Comparison of vital signs and comfort of elderly patients undergoing hip surgery with different anesthesia-assisted drugs combined with spinal anesthesia

作　　者：胡佳艳[1] 李翃斌[1] HU Jiayan;LI Hongbin(Department of Anesthesiology,Zhoushan Hospital in Zhejiang Province,Zhoushan 316000,China)

机构地区：[1]浙江省舟山医院麻醉科,浙江舟山316000

出　　处：《中国现代医生》2019年第9期116-120,共5页China Modern Doctor

基　　金：浙江省医药卫生一般研究计划(A类)(2016KYA182)

摘　　要：目的观察不同麻醉辅助用药复合腰麻对老年髋关节手术患者生命体征及舒适性的影响。方法选择2017年1月～2018年4月在舟山医院择期行髋关节手术腰麻患者60例,随机分为M、Y、R三组,M组给予咪达唑仑2.5～3 mg后改侧卧位进行腰麻操作。Y组先给予微泵注射右美托咪定0.6μg/kg,用时量注射法10 min内注射完毕,之后改变体位操作腰麻。R组微泵注射瑞芬太尼0.05μg/(kg·min),腰麻均选择腰2～3间隙。观察三组患者的配合度、术中舒适性、血流动力学以及不良反应。结果 Y组配合良好的患者比例高达100.0%,明显高于M组(50.0%)、R组(45.0%)。Y组患者舒适度评分显著高于M组、R组(P<0.05)。Y组患者满意度评分明显高于M组、R组(P<0.05)。Y、M、R三组麻醉辅助用药对血压、SPO_2的影响无显著性差异,且各组患者的血压、SPO_2基本平稳,相比于麻醉前基本无变化(P>0.05);Y组心率相对另外两组偏慢。Y组患者未出现任何不良反应,M组2例患者出现谵妄;R组1例患者出现恶心,1例患者出现呕吐。结论小剂量应用右美托咪定进行镇静镇痛可以提高有创操作的配合度,降低心肌氧耗,对血流动力学基本无影响,除心率有所减慢,不影响呼吸,明显提高术中舒适性,不良反应少,可以很好地应用于麻醉的术中管理。Objective To observe the effect of different anesthesia-assisted drugs combined with spinal anesthesia on vital signs and comfort in elderly patients undergoing hip surgery.Methods 60 patients with spinal anesthesia who underwent elective hip surgery from Zhoushan Hospital from January 2017 to April 2018 were randomly divided into group M,Y,and R.Group M was given midazolam 2.5-3 mg and then changed the lateral position for spinal anesthesia operation.The group Y was first injected with dexmedetomidine 0.6μg/kg by micropump,and the injection was completed within 10 min,and then the patients changed position for spinal anesthesia operation.Group R was injected with remifentanil 0.05μg/(kg·min)by micro pump,and the waist 2-3 gap was selected.The cooperation,intraoperative comfort,hemodynamics,and adverse reactions of the three groups were observed.Results The proportion of patients with goodcooperationin group Y was as high as 100.0%,which was significantly higher than that of group M(50.0%)and group R(45.0%).The comfort score of patients in group Y was significantly higher than that in group M and group R(P<0.05).The satisfaction score of patients in group Y was significantly higher than that in group M and group R(P<0.05).There were no significant differences in the effect of anesthesia of group Y,M,and R on blood pressure and SPO2,and the blood pressure and SPO2 of each group were basically stable,which were almost unchanged compared with those before anesthesia(P>0.05).The heart rate of group Y was relatively slower than that in the other two groups.There were no adverse reactions in the group Y,and 2 patients in the group M developed sputum.1 patient in the group R developed nausea and 1 patient developed vomiting.Conclusion Low dose of dexamethasone for sedative analgesia can improve the cooperation degree of invasive operation and reduce myocardial oxygen consumption.It has no effect on hemodynamics,except slowing down heart rate.It does not affect breathing,which can improve the intraoperative comfortand

关 键 词：麻醉辅助用药 腰麻 老年 髋关节 

分 类 号：R614[医药卫生—麻醉学]