右美托咪定联合七氟烷麻醉用于老年肱骨骨折术中对患者术后认知功能及血流动力学的影响  

The effect of dexmedetomidine combined with sevoflurane anesthesia on postoperative cognitive function and hemodynamics in elderly patients with humeral fractures during the operation

作　　者：康建勋 梁迪 牛春艳 Kang Jianxun;Liang Di;Niu Chunyan(Department of Anesthesiology,Chaoyang Central Hospital,Chaoyang 122000,China)

机构地区：[1]朝阳市中心医院麻醉科,朝阳122000

出　　处：《中国医师进修杂志》2022年第10期950-953,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨右美托咪定(Dex)联合七氟烷麻醉用于老年肱骨骨折术中对患者术后认知功能及血流动力学的影响。方法选择2018年1月至2020年6月在朝阳市中心医院行手术治疗的120例老年肱骨骨折患者,按非随机临床同期对照研究及患者自愿原则分为对照组(59例)和研究组(61例),两组均给予七氟烷吸入维持全身麻醉,研究组另给予Dex麻醉。比较两组手术前后认知功能、血流动力学指标、应激反应指标以及疼痛情况,并观察记录麻醉相关并发症情况。结果研究组气管插管后10 min(T1)、手术即刻(T2)、手术开始后30 min(T3)平均动脉压水平低于对照组,T2、T3和术毕即刻(T4)心率低于对照组,差异有统计学意义(P<0.05)。研究组术后去甲肾上腺素、皮质醇水平低于对照组[(0.92±0.19)mmol/L比(1.10±0.28)mmol/L、(213.69±20.83)μg/L比(258.43±28.27)μg/L],差异有统计学意义(P<0.05)。研究组术后3、7 d蒙特利尔认知评估量表评分高于对照组[(23.42±1.37)分比(21.39±1.53)分、(25.83±0.95)分比(25.14±0.99)分],差异有统计学意义(P<0.05)。研究组麻醉相关并发症发生率低于对照组[8.2%(5/61)比22.0%(13/59)],差异有统计学意义(χ^(2)=4.50,P<0.05)。结论Dex联合七氟烷应用于老年肱骨骨折患者麻醉中,有利于维持血流动力学稳定,减轻应激反应,促进认知功能恢复。Objective To study the effect of dexmedetomidine(Dex)combined with sevoflurane anesthesia on postoperative cognitive function and hemodynamics in elderly patients with humeral fractures during the operation.Methods A total of 120 elderly patients with humeral fractures diagnosed and treated in Chaoyang Central Hospital from January 2018 to June 2020 were selected and divided into the control group(59 cases)and the study group(61 cases)according to the non-randomized clinical concurrent controlled study and patients′voluntary principle.Sevoflurane inhalation was given to patients to maintain general anesthesia in two groups,while Dex anesthesia was given to the study group.Cognitive function,hemodynamics,stress response and pain were compared between the two groups before and after the operation,and anesthesia related complications were observed and recorded.Results The mean arterial pressure(MAP)in the study group at 10 min after endotracheal intubation(T1),operation time(T2),30 min after the beginning of the operation(T3)were lower than those in the control group,the heart rate(HR)in the study group at T2,T3 and the immediate time after the operation(T4)were lower than those in the control group,the differences were statistically significant(P<0.05).The levels of norepinephrine(NE)and cortisol(Cor)in the study group were lower than those in the control group after the surgery:(0.92±0.19)mmol/L vs.(1.10±0.28)mmol/L,(213.69±20.83)μg/L vs.(258.43±28.27)μg/L,the differences were statistically significant(P<0.05).The scores of Montreal Cognitive Assessmentin the study group on 3,7 d after the operation were higher than those in the control group:(23.42±1.37)points vs.(21.39±1.53)points,(25.83±0.95)points vs.(25.14±0.99)points,the differences were statistically significant(P<0.05).The incidence of anesthesia related complications in the study group was lower than that in the control group:8.2%(5/61)vs.22.0%(13/59),χ^(2)=4.50,P<0.05.Conclusions The application of Dex combined with sevoflurane in the anesth

关 键 词：肱骨骨折 麻醉 全身 血流动力学 认知 右美托咪定 七氟烷 

分 类 号：R614[医药卫生—麻醉学]