不同麻醉方式在老年髌骨骨折手术中的应用  

Clinical effects of different anesthesia in the operation of patella fracture in the elderly

作　　者：石川 董补怀 吴绪才 徐涛 SHI Chuan;DONG Bu-huai;WU Xu-cai;XU Tao(Department of Surgical Anesthesia,Xi'an Honghui Hospital,Xi'an 710054,Shaanxi,CHINA)

机构地区：[1]西安市红会医院手术麻醉一科,陕西西安710054

出　　处：《海南医学》2020年第13期1699-1701,共3页Hainan Medical Journal

基　　金：陕西省自然科学基金(编号:2016JM4025)。

摘　　要：目的探讨右美托咪定与髂筋膜腔隙阻滞(FICB)联合麻醉与全身麻醉在老年髌骨骨折手术中的应用效果。方法西安市红会医院关节外科于2018年4月至2019年5月期间收治的84例髌骨骨折患者以随机数表法分为观察组和对照组,每组42例,观察组给予右美托咪定联合FICB麻醉,对照组给予全身麻醉,比较两组患者围手术期血流动力学变化及术中镇痛效果。结果两组患者术前的心率(HR)和平均动脉压(MAP)比较差异均无统计学意义(P>0.05);术中观察组患者的HR和MAP分别为(65.2±5.1)次/min、(78.3±6.8) mmHg,明显低于对照组的(68.7±5.4)次/min、(84.5±7.1) mmHg,差异均具有统计学意义(P<0.05);术后观察组患者的HR为(73.2±5.6)次/min,明显低于对照组的(77.4±5.8)次/min,差异具有统计学意义(P<0.05),但两组患者术后的MAP比较差异无统计学意义(P>0.05);两组患者手术过程中硝酸甘油使用率比较差异无统计学意义(P>0.05),但观察组患者的多巴胺使用率为4.8%,明显低于对照组的19.0%,差异具有统计学意义(P<0.05);观察组患者术中的瑞芬太尼使用剂量与术中镇痛药物追加次数分别为(0.65±0.26) mg、(2.10±0.46)次,明显少于对照组的(1.13±0.27) mg、(3.67±0.49)次,差异均具有统计学意义(P<0.05)。结论右美托咪定联合FICB的麻醉方式在髌骨骨折手术中能够更好的维持患者血流动力学稳定,同时具有良好的镇静、镇痛作用,值得推广。Objective To discuss the clinical effects of anesthesia with dexmedetomidine combined with fascia iliaca compartment block and general anesthesia in the operation of patella fracture in the elderly. Methods Eighty-four elderly patients with patella fracture admitted in Xi’an Honghui Hospital from April 2018 to May 2019 were randomly divided into the observation group(n=42) and the control group(n=42). The observation group was given dexmedetomidine and FICB for anesthesia, and the control group was given general anesthesia. Then the perioperative hemodynamic changes and analgesic effect were compared between the two groups. Results There was no significant difference in HR and MAP between the two groups before the operation(P>0.05). But HR and MAP in the observation group were(65.2±5.1) beats/min and(78.3±6.8) mm Hg during hour after operation, significantly lower than(68.7±5.4) beats/min and(84.5±7.1) mmHg in the control group(P<0.05). HR in the observation group were(73.2±5.6) beats/min after the operation, significantly lower than(77.4±5.8) beats/min in the control group(P<0.05). No significant difference was found in MAP between the two groups after the operation(P>0.05). Dopamine use rate in the observation group were 4.8%,significantly lower than 19.0% in the control group(P<0.05). The dosage of remifentanil and the number of additional analgesic drugs during operation in the observation group were(0.65±0.26) mg and(2.10±0.46) times, significantly lower than(1.13±0.27) mg and(3.67±0.49) times in the control group(P<0.05). Conclusion The anesthesia of dexmedetomidine combined with FICB can maintain the stability of hemodynamics better in the operation of patella fracture in the elderly, and has good sedative and analgesic effects, which is worthy of promotion.

关 键 词：右美托咪定 髂筋膜腔隙阻滞 老年 髌骨骨折 手术 麻醉 

分 类 号：R683.42[医药卫生—骨科学]