右美托咪啶辅助腰丛-坐骨神经阻滞麻醉下行膝关节置换术老年患者的麻醉效果及对认知功能影响分析  

Anesthesia effect of dexmedetomidine-assisted lumbar plexus-sciatic nerve block anesthesia for elderly patients undergoing knee arthroplasty and analysis of the effect on cognitive function

作　　者：李津 董红启 谭培培 罗凤侠 梁国庆 LI Jin;DONG Hong-qi;TAN Pei-pei(Department of Anesthesiology,Second People's Hospital of Fuyang City,Fuyang Anhui 236000,China)

机构地区：[1]阜阳市第二人民医院麻醉科,安徽阜阳236000 [2]陕西省核工业二一五医院麻醉科,陕西咸阳712000

出　　处：《临床和实验医学杂志》2021年第16期1768-1772,共5页Journal of Clinical and Experimental Medicine

基　　金：安徽省卫生厅科研项目(编号:1600K0125)。

摘　　要：目的分析右美托咪定辅助腰丛-坐骨神经阻滞麻醉下行膝关节置换术的麻醉效果以及对老年患者认知功能的影响。方法前瞻性选取阜阳市第二人民医院收治的64例行膝关节置换术的老年患者为研究对象,按随机数字表法将纳入对象分为研究组(32例)和对照组(32例)。所有患者均采取腰丛-坐骨神经阻滞麻醉,对照组给予咪唑安定辅助麻醉,研究组则给予右美托咪定辅助麻醉。比较两组患者麻醉效果,记录不同时间点[入室前(T_(0))、完成阻滞开始手术前(T_(1))、手术开始后10 min(T_(2))、置换关节时(T_(3))、术毕即刻(T_(4))]的血流动力学变化,统计围手术期不良反应发生情况,评估两组患者术前和术后4 h的认知功能变化情况。结果两组患者的心率、MAP在不同时间点间的数据差异有统计学意义(P<0.05),对照组T_(2)、T_(3)时的心率及T_(1)~T_(3)时的MAP均高于T_(0)时(P<0.05),研究组T_(1)~T_(4)时的心率值均低于T_(0)时(P<0.05),研究组T_(2)时的MAP值均低于T_(0)时(P<0.05)。两组患者的SpO2在不同时间点间的数据差异无统计学意义(P>0.05);研究组T_(1)~T_(4)时的心率水平及T_(2)、T_(3)时的MAP水平均低于对照组同时间点(P<0.05)。对照组与研究组的SpO_(2)数据差异无统计学意义(P>0.05)。研究组不良反应发生率为15.63%,显著低于对照组的37.50%,差异有统计学意义(P<0.05)。两组术前的认知功能各项目比较,差异均无统计学意义(P>0.05)。术后4 h,两组患者各项认知功能评分均较术前明显降低,但研究组各项认知功能评分高于对照组,差异均有统计学意义(P<0.05)。结论对行膝关节置换术的老年患者实施右美托咪定辅助腰丛-坐骨神经阻滞麻醉效果显著,能够维持患者血流动力学稳定,减轻对患者术后认知功能的影响,且不良反应较少,值得推广。Objective To analyze the anesthetic effect of dexmedetomidine-assisted lumbar plexus-sciatic nerve block anesthesia for knee arthroplasty and its impact on the cognitive function of elderly patients. Methods Sixty-four elderly patients undergoing knee arthroplasty who were admitted to Fuyang Second People’s Hospital were prospectively selected as the research objects. All included subjects were divided into study group(32 cases) and control group(32 cases) according to the random number table method. All patients were given lumbar plexus-sciatic nerve block anesthesia,the control group was given midazolam auxiliary anesthesia,and the study group was given dexmedetomidine auxiliary anesthesia. The anesthesia effects of the two groups of patients were recorded,different time points [before entering the room(T_(0)),before completing the block and starting the operation(T_(1)),10 minutes after the start of the operation(T_(2)),when the joint was replaced(T_(3)),immediately after the operation(T_(4)) ]hemodynamic changes were compared,The incidence of adverse reactions during the perioperative period was counted,and the cognitive function changes of the two groups of patients before and 4 hours after the operation were evaluated. Results The data difference of HR and MAP between the two groups of patients at different time points was statistically significant(P<0.05). The HR at T_(2) and T_(3) and the MAP at T_(1)~ T_(3) of the control group were higher than those at T0(P<0.05). The HR values of the study group at T_(1)~ T_(4) were all lower than at T_(0)(P<0.05). The MAP values at T_(2) in the study group were all lower than at T_(0)(P<0.05). There was no statistically significant difference in SpO_(2) data between the two groups of patients at different time points(P>0.05);The HR level at T_(1)~ T_(4) and the MAP level at T_(2) and T3 in the study group were lower than those in the control group at the same time point(P<0.05). The incidence of adverse reactions in the study group was 15. 63%,which was significantl

关 键 词：膝关节置换术 右美托咪定 腰丛-坐骨神经阻滞麻醉 麻醉效果 认知功能 

分 类 号：R614[医药卫生—麻醉学]