右美托咪定对老年胸腰椎骨折内固定手术患者术后脑保护效应  

Cerebral protective effect of dexmedetomidine on elderly patients with thoracolumbar spine fracture undergoing internal fixation

作　　者：罗康 王永胜[2] 雷马文 周波 Luo Kang;Wang Yongsheng;Lei Mawen;Zhou Bo(Department of Anesthesiology,Third Affiliated Hospital of South China University,Hengyang,Hunan,421900,R.P.China;Department of Anesthesiology,People's Hospital of Hunan Province,Changsha,Hunan,410005,P.R.China;Department of An-esthesiology,First People's Hospital of Chenzhou City,Chenzhou,Hunan,423000,P.R.China;Department of Anesthesiology,Sijing Hospital of Songjiang District,Shanghai,201600,P.R.China)

机构地区：[1]南华大学附属第三医院麻醉科,湖南衡阳421900 [2]湖南省人民医院麻醉科,湖南长沙410005 [3]郴州市第一人民医院麻醉科,湖南郴州423000 [4]上海市松江区泗泾医院麻醉科,上海201600

出　　处：《老年医学与保健》2021年第4期834-837,共4页Geriatrics & Health Care

摘　　要：目的研究右美托咪定对老年胸腰椎骨折内固定手术患者的术后脑保护效应。方法选取南华大学附属第三医院2016年2月-2020年12月收治的121例老年胸腰椎骨折患者,采用随机数字表法分为试验组(n=60)和对照组(n=61)。试验组进行基础治疗加用泵注右美托咪定并维持,而对照组进行基础治疗加用等量生理盐水。观察并对比2组患者手术指标,以及入手术室后(T0)、右美托咪定负荷量后(T1)、麻醉诱导用药前(T2)、麻醉诱导后(T3)、手术结束时(T4)和拔管后(T5)的平均动脉压(MAP)和心率(HR)。对比2组患者手术前后6 h和24 h简易精神状态评价量表(MMSE)评分、蒙特利尔认知评估量表(MoCA)评分和疼痛视觉模拟(VAS)评分。结果治疗后,2组在T1、T2、T3、T4和T5时MAP和HR比较差异具有统计学意义(P<0.05);试验组T1、T2、T3和T5时MAP和HR高于同组T0时(P<0.05),而对照组T1、T2、T3、T4和T5时MAP和HR高于同组T0时(P<0.05)。与治疗前比较,2组手术后6h的MMSE和MoCA评分均有所降低,而试验组的MMSE和MoCA评分显著高于对照组(P<0.05);与手术后6 h比较,2组手术后24 h的MMSE和MoCA评分均升高,且试验组的MMSE和MoCA评分显著高于对照组(P<0.05)。手术后2组VAS评分均低于同组治疗前(P<0.05),且试验组VAS评分明显低于对照组(P<0.05)。2组手术时间、苏醒时间、术中出血量以及拔管时间差异均无统计学意义(P>0.05)。结论右美托咪定对老年胸腰椎骨折内固定手术患者术后脑保护效应较高,同时镇痛效果也较明显,具有一定的临床应用价值。Objective To analyze the cerebral protective effect of dexmedetomidine on elderly patients with thoracolumbar spine fracture undergoing internal fixation.Methods 121 elderly patients with thoracolumbar fractures treated in the Third Affiliated Hospital of South China University from February 2016 to December 2020 were enrolled,and randomly divided into experimental group(n=60)and control group(n=61).The experimental group received basic treatment plus intraoperative continuous pump injection of dexmedetomidine,while the control group received basic treatment plus the same amount of normal saline.It was observed and compared between the two groups that the operation indexes,as well as mean arterial pressure(MAP)and heart rate(HR)after entering the operating room(T0),after dexmedetomidine loading(T1),before anesthesia induction(T2),after anesthesia induction(T3),at the end of operation(T4)and after extubation(T5).The scores of the Mini-Mental State Evaluation Scale(MMSE),Montreal Cognitive Assessment Scale(MoCA)and pain Visual Analogue Scale(VAS)at postoperative 6 h and 24 h were compared between the two groups.Results After treatment,there was significant difference in MAP and HR at T1,T2,T3,T4 and T5 between the two groups(P<0.05).MAP and HR at T1,T2,T3 and T5 of the experimental group were higher than those at T0 of the same group(P<0.05),while MAP and HR at T1,T2,T3,T4 and T5 of the control group were higher than those at T0 of the same group(P<0.05).Compared with before treatment,the MMSE and MOCA scores of the two groups decreased 6 hours after operation,while the MMSE and MOCA scores of the experimental group were significantly higher than those of the control group(P<0.05);Compared with 6 hours after operation,the MMSE and MOCA scores of the two groups increased 24 hours after operation,and the MMSE and MOCA scores of the experimental group were significantly higher than those of the control group(P<0.05).After operation,the VAS scores of the two groups were lower than those of the same group before treatme

关 键 词：老年 胸腰椎骨折 内固定手术 右美托咪定 脑保护效应 

分 类 号：R614[医药卫生—麻醉学]