腰硬联合麻醉前应用右美托咪定对老年髋关节置换术患者的影响  

Effect of Dexmedetomidine Application before Combined Stiff Loin and Anesthesia on Elderly Hip Arthroplasty Patients

作　　者：祁恩耀 周颖[1] 王鹏[1] 许娟[1] QI Enyao;ZHOU Ying;WANG Peng;XU Juan(Department of Anesthesiology,the First Affiliated Hospital of China Pharmaceutical University(Nanjing Liuhe District People's Hospital),Nanjing,Jiangsu Province,211500 China)

机构地区：[1]中国药科大学第一附属医院(南京市六合区人民医院)麻醉科,江苏南京211500

出　　处：《系统医学》2023年第2期78-81,86,共5页Systems Medicine

基　　金：南京市2019年度科技发展计划项目(YKK19139)。

摘　　要：目的探讨对老年髋关节置换术患者腰硬联合麻醉前予右美托咪定干预的效果。方法选择中国药科大学第一附属医院(南京市六合区人民医院)2019年3月—2021年12月收治的老年髋关节置换术患者120例作为研究对象,随机分为行常规腰硬联合麻醉的对照组(n=60)与术前应用右美托咪定干预的观察组(n=60)。比较两组术前、术中生命体征水平,另于术后30 min、12 h分别以Ramsay镇静评分与视觉模拟法(VAS)评分评估镇静、镇痛效果,比较两组术前术后不同时刻的认知功能,并检测两组术前、术后肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)、白介素-6(IL-6)水平评估炎症反应状态。结果观察组术中平均动脉压(84.95±6.03)mmHg、心率(67.15±4.14)次/min、呼吸频率(17.65±2.31)次/min,均小于对照组,差异有统计学意义(t=4.499、5.359、5.532,P<0.001)。观察组术后12 h的Ramsay评分(2.40±0.49)分高于对照组,VAS评分(1.04±0.24)分低于对照组,差异有统计学意义(t=4.075、7.376,P<0.05)。观察组术后12、24 h的简明精神状态量表MMSE评分(24.06±1.65)分、(26.15±1.70)分高于对照组,差异有统计学意义(t=5.218、4.849,P<0.05)。术后观察组TNF-α(39.52±6.17)pg/mL、CRP(24.55±2.65)mg/L、IL-6(34.24±4.60)pg/mL,均小于对照组,差异有统计学意义(t=19.523、21.982、12.549,P<0.05)。结论对老年髋关节置换术患者在腰硬联合麻醉前予右美托咪定干预能维持术中血流动力学指标稳定,可提高术后镇静、镇痛效果,改善患者术后认知功能,并可抑制炎性反应。Objective To investigate the effect of dexmedetomidine intervention before combined stiff loin and anesthesia on elderly hip arthroplasty patients.Methods 120 elderly hip arthroplasty patients admitted to the First Affiliated Hospital of China Pharmaceutical University(Nanjing Liuhe District People's Hospital)from March 2019 to December 2021 were selected as the research object.They were randomly divided into a control group(n=60)with conventional combined stiff loin and anesthesia and an observation group(n=60)with preoperative application of dexmedetomidine intervention.The levels of preoperative and intraoperative vital signs were compared between the two groups.In addition,the sedative and analgesic effects were assessed by Ramsay sedation score and Visual Analogue Score(VAS)at 30 min and 12 h postoperatively,respectively.The cognitive functions of the two groups were compared at different moments before and after surgery,and the preoperative and postoperative levels of tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and interleukin-6(IL-6)were measured to assess the inflammatory response status.Results The mean intraoperative arterial pressure(84.95±6.03)mmHg,heart rate(67.15±4.14)beats/min,and respiratory rate(17.65±2.31)beats/min in the observation group were smaller than those in the control group,the difference was statistically significant(t=4.499,5.359,5.532,P<0.001).The Ramsay score at 12 h postoperatively(2.40±0.49)points in the observation group was higher than that in the control group,and the VAS score(1.04±0.24)points was lower than that in the control group,the difference was statistically significant(t=4.075,7.376,P<0.05).The Mini-Mental Sate Examination(MMSE)scores at 12 h and 24 h postoperatively were(24.06±1.65)points and(26.15±1.70)points in the observation group,which were higher than those in the control group,the difference was statistically significant(t=5.218,4.849,P<0.05).Postoperatively,TNF-α(39.52±6.17)pg/mL,CRP(24.55±2.65)mg/L and IL-6(34.24±4.60)pg/mL in the obs

关 键 词：腰硬联合麻醉 老年 髋关节置换术 右美托咪定 生命体征 认知功能 

分 类 号：R614[医药卫生—麻醉学]