右美托咪定滴鼻联合腹股沟韧带上髂筋膜阻滞对股骨近端骨折病人术前镇静效果的影响  

Effect of intranasal dexmedetomidine combined with suprainguinal fascia iliaca block as a preopera⁃tive sedation for patients with proximal femoral fracture

作　　者：林澄 陈治军[1] 秦朝生 龙小菊 LIN Cheng;CHEN Zhi-jun;QIN Chao-sheng;LONG Xiao-ju(Department of Anesthesiology,the Affiliated Hospital of Guilin Medical University,Guilin 541000,China)

机构地区：[1]桂林医学院附属医院麻醉科,广西桂林541001

出　　处：《骨科》2020年第5期427-430,共4页ORTHOPAEDICS

基　　金：广西壮族自治区卫生健康委员会计划课题资助项目(Z2016397)。

摘　　要：目的探讨右美托咪定滴鼻联合腹股沟韧带上髂筋膜阻滞(suprainguinal fascia iliaca block,SIFIB)对股骨近端骨折病人术前镇静效果的影响。方法收集60例拟行股骨近端骨折手术的病人,按随机数字表法分为三组:0.5μg/kg右美托咪定滴鼻组(D1组)、1μg/kg右美托咪定滴鼻组(D2组)以及给予生理盐水滴鼻的对照组。三组病人入室后分别滴注对应的滴鼻剂,而后行超声引导下SIFIB(0.375%罗哌卡因30 ml),神经阻滞20 min后开始摆体位穿刺。记录滴鼻前(T0)、神经阻滞时(T1)、神经阻滞后10 min(T2)、体位摆放成功即刻(T3)的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)、疼痛视觉模拟量表(visual analogue scale,VAS)评分、Ramsay镇静评分和焦虑评分。结果T2时,D1组、D2组的心率明显较对照组慢,D2组的Ramsay镇静评分明显高于D1组和对照组,焦虑评分明显低于D1组和对照组;T3时,D1组、D2组的心率明显较对照组慢,D2组的焦虑评分明显低于D1组和对照组。结论股骨近端骨折手术病人麻醉前给予右美托咪定1μg/kg滴鼻联合SIFIB可获得良好的术前镇静效果,减少病人的焦虑。Objective To investigate the effect of intranasal dexmedetomidine combined with suprainguinal fascia iliaca block(SIFIB)on the preoperative sedation of patients with proximal femoral fracture.Methods A total of 60 patients with proximal femoral fracture undergoing surgery were randomly divided into three groups:0.5μg/kg intranasal dexmedetomidine group(group D1),1μg/kg intranasal dexmedetomidine group(group D2)and control group.After admission,the patients in group D1 or D2 were given intranasal dexmedetomidine respectively,and control group was given intranasal normal saline.All the patients received ultrasound guided suprainguinal fascia iliaca block(SIFIB,0.375%ropivacaine 30 ml).Positioning was performed 20 min after SIFIB.Mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2),visual analogue scale(VAS)score,Ramsay sedation scores and anxiety scores were recorded before intranasal(T0),at nerve block(T1),10 min after nerve block(T2),and placing spinal anesthesia position(T3).Results Compared with control group,HR at T2 in group D1 and group D2 slowed down.The scores of Ramsay at T2 was higher and the scores of anxiety was lower in group D2 than in group D1 and control group.HR at T3 in group D1 and group D2 was slower than in control group.The scores of anxiety at T3 was lower in group D2 than in group D1 and control group.Conclusion Intranasal premedication with dexmedetomidine(1μg/kg)combined with SIFIB in patients with proximal femoral fracture undergoing surgery could achieve favorable sedation level,and induce a favorable preoperative anxiolysis.

关 键 词：右美托咪定 滴鼻 腹股沟韧带上髂筋膜阻滞 

分 类 号：R614[医药卫生—麻醉学]