不同剂量右美托咪定联合脊椎麻醉对老年髋关节置换术患者术后镇痛效果的影响  

Effect of different doses of dexmedetomidine combined with spinal anesthesia on postoperative analgesia in elderly patients with hip replacement

作　　者：龚珺卿 汪春华 刘金生 谢文 GONG Junqing;WANG Chunhua;LIU Jinsheng;XIE Wen Jiangxi(Jiayou Shuguang Orthopedic Hospital,Nanchang,Jiangxi 330000,China)

机构地区：[1]江西嘉佑曙光骨科医院,江西南昌330000

出　　处：《检验医学与临床》2023年第9期1194-1197,共4页Laboratory Medicine and Clinic

基　　金：江西省南昌市指导性科技计划项目(洪城发计字[2018]39号第6、7项)。

摘　　要：目的探讨不同剂量右美托咪定(Dex)联合脊椎麻醉对老年髋关节置换术(THA)患者术后镇痛效果的影响。方法选择2019年1至2022年1月于该院行THA治疗的132例老年患者作为研究对象,按照随机数字表法将其分为对照组、D1组和D2组,每组44例。所有患者均行脊椎麻醉,D1组静脉输注0.5μg/kg的Dex,D2组静脉输注1.0μg/kg的Dex,术中两组均以0.2μg/(kg·h)静脉输注维持麻醉,至手术结束前5 min停药;对照组输注等体积的0.9%氯化钠注射液。比较3组镇痛效果[视觉模拟评分法(VAS)评分、舒适度量表(BCS)评分]、不同时间点血流动力学指标水平、首次补救镇痛时间、补救镇痛率及不良反应发生情况。结果D1组与D2组术后4、12 h的VAS评分低于对照组,BCS评分高于对照组,差异均有统计学意义(P<0.05);D1组T2、T3时心率及平均动脉压低于D2组及对照组,且D2组T2、T3时平均动脉压低于对照组,差异均有统计学意义(P<0.05),但3组不同时间点中心静脉压及血氧饱和度比较,差异无统计学意义(P>0.05);D1组与D2组的首次补救镇痛时间长于对照组,而补救镇痛率低于对照组,差异均有统计学意义(P<0.05);D2组总不良反应发生率高于对照组,差异有统计学意义(P<0.05);D1组与D2组术后4、12 h的VAS评分及BCS评分、首次补救镇痛时间、补救镇痛率及不良反应发生率比较,差异无统计学意义(P>0.05)。结论0.5μg/kg的Dex联合脊椎麻醉用于老年THA患者中能够延长镇痛时间、增强镇痛效果,提高患者围术期舒适度,满足临床麻醉需求,且不良反应相对较少。Objective To investigate the effect of different doses of dexmedetomidine(Dex)combined with spinal anesthesia on postoperative analgesia in elderly patients undergoing hip replacement(THA).Methods A total of 132 elderly patients who were treated with THA in the hospital from January 2019 to January 2022 were selected and randomly divided into control group,D1 group and D2 group,44 cases in each group.All patients received spinal anesthesia,and the D1 group was with 0.5μg/kg Dex for intravenous infu-sion,the D2 group was with 1.0μg/kg Dex,0.2μg/(kg·h)was maintained during the operation,and the drug was stopped 5 minutes before the end of operation.The control group was infused with 0.9%sodium chloride injection of equal volume.The analgesic effect[visual analogue scale(VAS)score],comfort level[Bruggrmann comfort scale(BCS)socre],hemodynamic indexes at different time points,the time of first res-cue analgesia,the rate of rescue analgesia and incidence of adverse reaction were compared among the three groups.Results The VAS scores of D1 group and D2 group were lower than those of the control group at 4,12 hours after operation,and the BCS scores were higher than those of the control group,the differences were statistically significant(P<0.05).Heart rate and mean arterial pressure at T2,T3 in the D1 group were low-er than those in the D2 group and the control group,and the mean arterial pressure at T2,T3 in the D2 group were lower than those in the control group,the differences had statistical significance(P<0.05),but the differences of central venous pressure and oxyhemoglobin saturation at different points among the three groups had no statistical significance(P<0.05).The first rescue analgesia time of D1 group and D2 group was longer than that of the control group,and the rescue analgesia rate was lower than that of the control group,the differences were statistically significant(P<0.05).The total adverse reaction rate of D2 group was higher than that of the control group with statistically significant differe

关 键 词：老年髋关节置换术 右美托咪定 脊椎麻醉 术后镇痛效果 不良反应 

分 类 号：R614.41[医药卫生—麻醉学]