右美托咪定联合利多卡因局麻对行椎体成形术的老年骨质疏松性骨折患者麻醉效果的影响  

Effect of dexmedetomidine combined with lidocaine on anesthesia in elderly patients with osteoporotic fracture undergoing PVP

作　　者：徐帅 韩丽春 XU Shuai;HAN Li-chun(Department of Anesthesiology,Xi'an Daxing Hospital,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xi'an 710000,Shaanxi,China)

机构地区：[1]陕西省中医药大学附属医院·西安大兴医院麻醉科,陕西西安710000

出　　处：《川北医学院学报》2021年第10期1347-1351,共5页Journal of North Sichuan Medical College

基　　金：陕西省西安市卫生健康委员会科研项目(2020yb73)。

摘　　要：目的:探讨右美托咪定联合利多卡因局麻对行椎体成形术(PVP)老年骨质疏松性骨折患者麻醉效果的影响。方法:按照麻醉方式不同将行PVP手术治疗的106例老年骨质疏松性骨折患者分为研究组(n=57)和对照组(n=49),两组均给予利多卡因进行局部麻醉,随后研究组患者加用右美托咪定,对照组给予同量生理盐水。比较两种不同麻醉方式的麻醉效果,并分析对患者认知功能、循环稳定功能、疼痛程度的影响。结果:研究组的感觉阻滞、运动阻滞起效时间均短于对照组,持续时间均长于对照组,最高平面、达最高平面时间均低于对照组(P<0.05);麻醉后20 min(T1)、麻醉后1 h(T2)时间段两组心率(HR)均升高,T1两组平均动脉压(MAP)、中心静脉压(CVP)均升高,而T2点较T1点降低,且两组在T1、T2时间段的HR、MAP、CVP水平比较差异有统计学意义(P<0.05);T1时刻两组血清白细胞介素6(IL-6)、肿瘤坏死因子(TNF-α)水平较麻醉前(T0)时刻明显升高,研究组的以上指标均低于对照组(P<0.05),T2时刻两组IL-6、TNF-α指标均降低,研究组以上指标也低于对照组(P<0.05);两组在T0、T1、T2时刻认知功能(MMSE)评分比较均无统计学差异(P>0.05),两组在T0时刻VAS评分比较无统计学差异(P>0.05),但在T1时刻两组疼痛(VAS)评分均显著降低,T2时刻两组VAS评分有所升高,研究组在T1、T2时刻VAS评分均低于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:右美托咪定联合利多卡因局麻在行PVP治疗的老年骨质疏松性骨折患者中麻醉效果较佳,可改善循环功能稳定性,减少机体炎症反应及疼痛程度,应用安全,且不会对患者认知功能产生影响,推荐在临床应用。Objective:To investigate the influence of dexmedetomidine combined with lidocaine on anesthesia in elderly patients with osteoporotic fractures undergoing percutaneous vertebroplasty(PVP).Methods:106 elderly patients with osteoporotic fractures who underwent PVP were divided into study group(n=57)and control group(n=49)according to the different anesthesia methods.Both groups were given lidocaine local anesthesia,and then the study group received intravenous injection of dexmedetomidine for anesthesia,while the control group received intravenous injection of the same dose of normal saline.Anesthesia effects of the two methods were compared,and the influence on patients cognitive function,stability of circulatory function,and pain degree was analyzed.Results:The onset time of sensory block and motor block was significantly shorter in the study group than those in the control group,but the duration was longer than that in the control group.Besides,the block level and the time to the highest level were significantly lower and shorter than the control group(P<0.05).Heart rate(HR)significantly increased in the 2 groups at 20min(T1)and 1h after the beginning of anesthesia(T2).The mean arterial pressure(MAP)and central venous pressure(CVP)significantly increased at T1,and were significantly higher than those at T2.Significant differences were found in HR,MAP,and CVP between the 2 groups at T1 and T2(P<0.05).At T1,interleukin-6(IL-6)and tumor necrosis factor(TNF-α)in the two groups were significantly higher than those before anesthesia(T0),which were significantly lower in the study group than in the control group(P<0.05).At T2,the two indicators significantly decreased in the 2 groups,which were significantly lower in the study group than in the control group(P<0.05).There was no statistically difference in MMSE scores between the two groups at T0,T1 and T2(P>0.05),and there was no statistically difference in VAS scores between the two groups at T0(P>0.05).However,VAS scores of the two groups significantly decreased at

关 键 词：骨质疏松性骨折 右美托咪定 利多卡因 PVP 老年 循环功能稳定性 

分 类 号：R614.3[医药卫生—麻醉学] R687.3[医药卫生—外科学]