右美托咪定单用及联合瑞芬太尼应用于膝关节置换术对患者术中应激反应及术后康复进程的影响  

Effect of dexmedetomidine alone and in combination with remifentanil applied in knee arthroplasty on intraoperative stress response and postoperative rehabilitation process of patients

作　　者：张志敏[1] 牛小龙[2] 李璐[1] 武广义[1] 甘璐 ZHANG Zhi-min;NIU Xiao-long;LI Lu;WU Guang-yi;GAN Lu(Department of Anesthesiology,Affiliated Hospital of Hebei University,Baoding 071000,China;Department of Anatomy,Faculty of Medicine,Hebei University,Baoding 071000,China)

机构地区：[1]河北大学附属医院麻醉科,河北保定071000 [2]河北大学医学部解剖教研室,河北保定071000

出　　处：《实用药物与临床》2022年第5期400-403,共4页Practical Pharmacy and Clinical Remedies

基　　金：保定市科技局项目(2041ZF168);河北大学附属医院基金项目(2021Q011)。

摘　　要：目的观察右美托咪定单用及联合瑞芬太尼在膝关节置换术中的应用效果及对术中应激反应、术后康复进程的影响。方法选取2021年1-6月于我院行膝关节置换术的120例患者为研究对象,根据随机数字表法将入选对象分为研究组与对照组,各60例。其中对照组患者予以右美托咪定镇痛,研究组在对照组的基础上联合应用瑞芬太尼。比较两组患者手术情况,记录不同时间点应激指标、疼痛程度的变化,并观察术后康复效果及不良反应发生情况。结果两组患者手术时间、术中出血量及液体输入量比较差异无统计学意义(P>0.05);术前两组肾上腺素(AD)、去甲肾上腺素(NE)水平比较差异无统计学意义(P>0.05),给药20 min、气管插管时均有所提高(P<0.05),但研究组低于对照组(P<0.05);术后6 h、12 h研究组疼痛数字评分(NRS)显著低于对照组(P<0.05);术后下床活动时间及住院时长均短于对照组(P<0.05),研究组并发症发生率略低于对照组,但差异无统计学意义(P>0.05)。结论右美托咪定联合瑞芬太尼用于老年患者膝关节置换术,其效果显著优于右美托咪定单用,不仅能降低患者围术期应激反应,还能缓解术后疼痛,缩短住院时间,对于患者早期康复具有重要意义。Objective To observe the application effects of dexmedetomidine alone and in combination with remifentanil in knee arthroplasty,and the influence on intraoperative stress response and postoperative rehabilitation process.Methods A total of 120 patients undergoing knee arthroplasty in the hospital from January 2021 to June 2021 were selected as the research subjects.According to random number table method,the patients enrolled were divided into study group and control group,with 60 cases in each group.Patients in control group were given dexmedetomidine analgesia,and patients in study group were given dexmedetomidine combined with remifentanil.Surgical conditions in the two groups were compared.Changes in stress indicators and pain degree at different time points were recorded.The postoperative rehabilitation and adverse reactions were observed.Results There was no statistically significant difference in operation time,intraoperative blood loss or volume of fluid infused between the two groups(P>0.05).The levels of adrenaline(AD)and norepinephrine(NE)levels showed no significant differences between the two groups before surgery(P>0.05),which were improved at 20 min after administration and at tracheal intubation(P<0.05),and the levels in the study group were lower than those in the control group(P<0.05).The study group had significantly lower numerical rating scale(NRS)scores than the control group at 6 h and 12 h after surgery(P<0.05).The postoperative ambulation time and the length of hospital stay of the study group were shorter than those of the control group(P<0.05).The incidence of complications in the study group was lower than that in the control group,but it was not statisti cally different(P>0.05).Conclusion Compared with dexmedetomidine alone,dexmedetomidine combined with remifentanil can achieve better effect in elderly patients undergoing total knee arthroplasty.It can not only reduce perioperative stress response,but also relieve postoperative pain and shorten the length of hospital stay,which is of

关 键 词：右美托咪定 瑞芬太尼 膝关节置换术 术中应激反应 康复 

分 类 号：R614[医药卫生—麻醉学]