帕瑞昔布钠复合右美托咪定超前镇痛对高龄髋关节骨折患者椎管内麻醉体位摆放期间镇痛效果的影响  

Effect of preemptive analgesia with parecoxib sodium combined with dexmedetomidine on elderly patients with hip fracture in body position placement during spinal anesthesia

作　　者：赵彦春[1] 陈丽华 赵丽艳[1] 于国军[1] 康定坤[1] ZHAO Yanchun;CHEN Lihua;ZHAO Liyan;YU Guojun;KANG Dingkun(Department of Anesthesiology,Luoyang Orthopedic-Traumatological Hospital of Henan Province—Henan Provincial Orthopaedic Hospital,Luoyang 471013,Henan,China)

机构地区：[1]河南省洛阳正骨医院〔河南省骨科医院〕麻醉科,河南洛阳471013

出　　处：《右江医学》2021年第9期663-667,共5页Chinese Youjiang Medical Journal

摘　　要：目的观察帕瑞昔布钠(PAX)复合右美托咪定(Dex)超前镇痛对高龄髋关节骨折(HF)患者椎管内麻醉体位摆放期间镇痛效果的影响。方法选择择期进行椎管内麻醉髋关节手术的99例HF患者,根据治疗方式不同将患者分为PAX组(n=33)、Dex组(n=33)和PAX+Dex组(n=33),PAX组予以PAX静脉滴注,Dex组予以Dex持续输注,PAX+Dex组予以PAX+Dex治疗,比较三组患者麻醉诱导前(T 0)、椎管内麻醉体位摆放期间(T 1)、麻醉后恢复平卧位(T 2)时的疼痛和镇静评分情况,记录术后舒芬太尼使用量、镇痛泵按压次数以及患者不良反应发生情况。结果PAX+Dex组T 0、T 1、T 2时VAS疼痛评分、RAMSAY镇静评分明显低于PAX组、Dex组(P<0.05);PAX+Dex组术后24 h舒芬太尼使用量及术后6 h、12 h镇痛泵按压次数均明显少于PAX组、Dex组(P<0.05);PAX+Dex组患者心动过缓发生率明显高于PAX组、Dex组(P<0.05),三组患者恶心呕吐、发热、腹泻、嗜睡等不良反应发生率比较,差异无统计学意义(P>0.05)。结论PAX复合Dex超前镇痛可减轻高龄HF患者椎管内麻醉体位摆放期间疼痛,维持患者镇静,起到良好的镇痛效果。Objective To observe the effect of preemptive analgesia with parecoxib sodium(PAX)combined with dexmedetomidine(Dex)on elderly patients with hip fracture(HF)in body position placement during spinal anesthesia.Methods 99 patients with HF who were selected for hip surgery under intravertebral anesthesia in our hospital were divided into PAX group(n=33),Dex group(n=33)and PAX+Dex group(n=33)according to different treatment methods.The PAX group were given intravenous drip of PAX,the Dex group were given continuous infusion of Dex,and the PAX+Dex group were given PAX+Dex treatment.And then,the scores of pain and sedation before anesthesia induction(T 0),during body position placement under intraspinal anesthesia(T 1),and recovering to supine position after anesthesia(T 2)were compared among the three groups,and the dosage of sufentanil,the times of analgesia pump compression and the incidence of adverse reactions were recorded.Results The VAS pain score and RAMSAY sedation score of the PAX+Dex group at T 0,T 1 and T 2 were significantly lower than those of the PAX group and the Dex group(P<0.05);The amount of sufentanil 24 h after surgery and the times of analgesia pump compression 6h and 12 h after surgery in the PAX+Dex group were significantly lower than those in the PAX and the Dex group(P<0.05);The incidence of bradycardia in the PAX+Dex group was significantly higher than that in the PAX group and the Dex group(P<0.05),and there was no statistically significant difference in the incidence of adverse reactions like nausea and vomiting,fever,diarrhea and lethargy among the three groups(P>0.05).Conclusion PAX combined with Dex preemptive analgesia can relieve the pain of elderly patients with HF during the position setting of spinal anesthesia,maintain patient's sedation and have a good analgesic effect.

关 键 词：帕瑞昔布钠 右美托咪定 高龄 髋关节骨折 血流动力学 

分 类 号：R614.2[医药卫生—麻醉学]