探讨右美托咪定对老年股骨颈骨折患者手术麻醉血流动力学及安全性的影响  

To explore the effect of dexmedetomidine on the hemodynamics and safety of anesthesia in elderly patients with femoral neck fracture

作　　者：李俊芳 邓燕[1] 杨夏[1] 张田田[1] 张抗抗[1] Li Junfang;Deng Yan;Yang Xia;Zhang Tiantian;Zhang Kangkang(Department of Anesthesiology,Tengzhou Central People′s Hospital,Tengzhou 277599,China)

机构地区：[1]滕州市中心人民医院麻醉科,山东滕州277599

出　　处：《中国临床实用医学》2021年第5期56-60,共5页China Clinical Practical Medicine

摘　　要：目的探讨右美托咪定对老年股骨颈骨折患者手术麻醉血流动力学及安全性的影响。方法选取2019年4月至2021年4月滕州市中心人民医院麻醉科收治的120例老年股骨颈骨折患者,男71例,女49例,年龄(72.22±4.12)岁,年龄范围为60~80岁。采用随机数表法将患者随机分为喷他佐辛组与右美托咪定组,每组60例,喷他佐辛组行喷他佐辛麻醉,右美托咪定组在喷他佐辛组基础上加用右美托咪定麻醉,比较两组患者不同时间点(麻醉前10 min、用药后30 min、手术结束时)收缩压、舒张压、心率、中心静脉压、脑电双频指数的变化,观察不同时间点肾素活性及去甲肾上腺素水平及术后不同时间点(术后1、6、12 h)视觉模拟评分法(VAS)评分、镇静程度评估表(RASS)评分,同时记录围术期不良反应。结果用药后30 min,右美托咪定组患者收缩压[(149.65±10.77)mmHg,1 mmHg=0.133 kPa]、舒张压[(95.74±8.27)mmHg]、心率[(86.02±5.33)次/分]低于喷他佐辛组[(161.99±11.50)mmHg、(99.10±7.24)mmHg、(89.98±6.12)次],中心静脉压[(94.77±5.58)mmHg]及脑电双频指数水平(64.77±8.53)高于喷他佐辛组[(88.48±6.14)mmHg、(49.50±7.27)],差异有统计学意义(P<0.05)。手术结束时,右美托咪定组患者收缩压[(143.98±7.26)mmHg]、舒张压[(97.11±6.36)mmHg]、心率[(74.96±6.33)次/分]低于喷他佐辛组[(155.98±8.13)mmHg、(102.36±8.14)mmHg、(85.99±5.41)次],差异有统计学意义(P<0.05)。用药后30 min,右美托咪定组患者肾素活性[(2.05±0.58)nmol/L]及去甲肾上腺素水平[(3.86±0.98)nmol/L]均低于喷他佐辛组[(3.89±0.24)nmol/L、(5.99±0.75)nmol/L],差异有统计学意义(P<0.05)。手术结束时,右美托咪定组患者肾素活性[(2.13±0.46)nmol/L]及去甲肾上腺素水平[(3.77±0.62)nmol/L]均低于喷他佐辛组[(3.43±0.86)nmol/L、(5.36±0.64)nmol/L],差异有统计学意义(P<0.05)。术后1、6、12 h,右美托咪定组患者VAS评分[(2.18±0.65)分、(2.33±0.67)分、(2Objective To explore and analyze the effect of dexmedetomidine on the hemodynamics and safety of anesthesia in elderly patients with femoral neck fractures.Methods A total of 120 elderly patients with femoral neck fractures admitted to the department of Anesthesiology,Tengzhou Central People′s Hospital from April 2019 to April 2021,71 males and 49 females,aged(72.22±4.12)years old,ranging from 60 to 80 years old.The patients were randomly divided into pentazocine group and dexmedetomidine group by random number table,60 cases in each group,pentazocine anesthesia was performed in the pentazocine group,and pentazocine anesthesia was performed in the dexmedetomidine group.The changes of systolic blood pressure,diastolic blood pressure,heart rate per minute,Central venous pressure and bispectral index were compared between the two groups at different time points(10 min before anesthesia,30 min after medication and at the end of operation),the renin activity and noradrenaline level at different time points,visual analogue scale(VAS)and richmond agitation-sedation scale(RASS)were observed at different time points(1,6,12 hours after operation),and the perioperative adverse reactions were recorded.Results Thirty minutes after administration,systolic blood pressure[(149.65±10.77)mmHg,1 mmHg=0.133 kPa],diastolic blood pressure[(95.74±8.27)mmHg],heart rate per minute[(86.02±5.33)times]in the dexmedetomidine group were lower than those in the pentazocine group[(161.99±11.50)mmHg,(99.10±7.24)mmHg,(89.98±6.12)mmHg],the level of central venous pressure[(94.77±5.58)mmHg]and bispectral index(64.77±8.53)were significantly higher than that of pentazocine group[(88.48±6.14)mmHg and(49.50±7.27)],the differences were statistically significant(P<0.05).At the end of operation,systolic blood pressure[(143.98±7.26)mmHg],diastolic blood pressure[(97.11±6.36)mmHg]and heart rate per minute[(74.96±6.33)times]in the dexmedetomidine group were lower than those in the pentazocine group[(155.98±8.13)mmHg,(102.36±8.14)mmHg,(85.99

关 键 词：右美托咪定 喷他佐辛 老年股骨颈骨折 手术麻醉 血流动力学 

分 类 号：R614[医药卫生—麻醉学]