盐酸右美托咪定联合轻比重腰麻对老年髋关节置换术后认知功能与应激反应的影响研究  

Study on the Effect of Dexmedetomidine Hydrochloride Combined with Light Heavy Weight Lumbar Anesthesia on Cognitive Function and Stress Response of Elderly People after Hip Arthroplasty

作　　者：王亚琴 吴捷 陈佳 王敏 WANG Yaqin;WU Jie;CHEN Jia;WANG Min(Department of Anesthesiology,Taizhou Integrated Hospital of Traditional Chinese and Western Medicine,Taizhou,Jiangsu Province,225300 China)

机构地区：[1]泰州市中西医结合医院麻醉科,江苏泰州225300

出　　处：《系统医学》2023年第15期79-83,共5页Systems Medicine

摘　　要：目的探讨盐酸右美托咪定联合轻比重腰麻对老年髋关节置换术后认知功能与应激反应的影响。方法选择2020年1月—2022年12月泰州市中西医结合医院收治老年髋关节置换术患者108例为研究对象,以随机数表法分为布比卡因轻比重腰麻的对照组(n=54)与联合盐酸右美托咪定干预的观察组(n=54),比较两组术前、术中、术毕循环指标(平均动脉压与心率),评估术前术后不同时刻简易精神状态量表(Mini-Mental State Examination,MMSE)评分,并检测术前、术后皮质醇(cortisol,Cor)、去甲肾上腺素(noradrenaline,NE)、肾上腺素(epinephrine,E)评估应激反应,另统计不良反应发生率。结果观察组术中、术毕时平均动脉压与心率均小于对照组,差异有统计学意义(P<0.05)。术后6 h、术后1 d,观察组MMSE评分均高于对照组,差异有统计学意义(P<0.05)。术后,观察组E、NE、Cor均低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率低于对照组(3.70%vs 14.81%),差异有统计学意义(χ^(2)=3.967,P<0.05)。结论老年髋关节置换术患者在轻比重腰麻基础上联用盐酸右美托咪定能改善循环状态,减轻认知受损与应激反应,并可降低不良反应风险。Objective To investigate the effects of dexmedetomidine hydrochloride combined with light heavy weight lumbar anesthesia on cognitive function and stress response after hip arthroplasty in the elderly.Methods A total of 108 elderly patients with hip replacement treated in Taizhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to December 2022 were selected as the study objects,and were divided into the control group with bupivacaine light heavy weight lumbar anesthesia(n=54)and the observation group combined with dexmedetomidine hydrochloride intervention(n=54)by random number table.Preoperative,intraoperative and postoperative circulation indexes(mean arterial pressure and heart rate)were compared between the two groups,and Mini-Mental State Examination(MMSE)scores were evaluated at different times before and after surgery,and cortisol(Cor),noradrenaline(NE)and epinephrine(E)were detected before and after surgery to assess the stress response,and the incidence of adverse reactions was measured.Results The mean arterial pressure and heart rate in the observation group were lower than those in the control group during and after surgery,and the difference was statistically significant(P<0.05).At 6 h and 1 d after surgery,MMSE scores in the observation group were higher than those in the control group,and the difference was statistically significant(P<0.05).After surgery,E,NE and Cor in observation group were lower than those in control group,and the difference was statistically significant(P<0.05).The incidence of adverse reactions in observation group was lower than that in control group(3.70%vs 14.81%),and the difference was statistically significant(χ^(2)=3.967,P<0.05).Conclusion Dexmedetomidine hydrochloride combined with light weight lumbar anesthesia can improve circulation,reduce cognitive impairment and stress response,and reduce the risk of adverse reactions in elderly patients with hip replacement.

关 键 词：老年 髋关节置换 盐酸右美托咪定 轻比重腰麻 布比卡因 认知功能 

分 类 号：R614[医药卫生—麻醉学]