右美托咪定联合目标导向液体治疗对老年髋部骨折手术患者脑组织氧代谢、术后恢复的影响  

Effect of dexmedetomidine combined with target-oriented fluid therapy on brain oxygen metabolism and postoperative recovery in elderly patients with hip fracture

作　　者：戚小航[1] 吴振宇[1] 孙东辉 张建刚[1] QI Xiao-hang;WU Zhen-yu;SUN Dong-hui(Department of Anesthesia,Qinhuangdao First Hospital,Qinhuangdao Hebei 066000,China;Department of Anesthesia,Qinhuangdao Maternal and Child Health Center,Qinhuangdao Hebei 066000,China.)

机构地区：[1]秦皇岛市第一医院麻醉科,河北秦皇岛066000 [2]秦皇岛市妇幼保健院麻醉科,河北秦皇岛066000

出　　处：《临床和实验医学杂志》2023年第19期2119-2122,共4页Journal of Clinical and Experimental Medicine

基　　金：2021年度河北省医学科学研究课题计划项目(编号:20211489);秦皇岛市科学技术研究与发展计划项目(编号:202101A045)。

摘　　要：目的 探讨右美托咪定联合目标导向液体治疗对老年髋部骨折手术患者脑组织氧代谢、术后恢复的影响。方法 前瞻性选取2019年5月至2022年5月秦皇岛市第一医院收治的120例老年髋部骨折手术患者,按照随机数字表法将其分为A组和B组,每组60例。两组术前10 min均予以右美托咪定泵注,A组术中采用常规补液,B组采用目标导向液体治疗。观察两组术前(T_(0))、蛛网膜下腔阻滞5 min(T_(1))及手术30 min(T_(2))的脑组织氧代谢[左、右局部脑氧饱和度(rScO_(2))]、平均动脉压(MAP)、心率以及术中低血压发生情况、术后认知功能恢复情况。结果 两组患者T_(0)的左rScO_(2)、右rScO_(2)、MAP、心率比较,差异均无统计学意义(P>0.05);B组T_(1)、T_(2)的左rScO_(2)分别为(68.41±4.76)%、(66.18±3.99)%,T_(1)、T_(2)的右rScO_(2)分别为(67.58±4.41)%、(65.17±3.85)%,均高于A组[(65.53±5.05)%、(62.15±4.02)%和(64.36±4.10)%、(61.09±3.96)%],差异均有统计学意义(P<0.05)。B组T_(1)、T_(2)的左rScO_(2)、右rScO_(2)均高于A组,差异均有统计学意义(P<0.05)。B组T_(1)、T_(2)的MAP水平分别为(95.97±5.16)、(95.44±4.22)mmHg,心率水平(82.95±4.63)、(85.40±4.75)次/min,均高于A组[MAP:(93.65±6.77)、(92.15±4.10)mmHg;心率:(79.95±4.74)、(82.36±5.10)次/min],B组术中低血压发生率为1.67%,低于A组(11.67%),差异均有统计学意义(P<0.05)。B组术后1、3 d的简易智能精神状态检查量表(MMSE)评分分别为(26.81±1.53)、(27.08±1.11)分,均高于A组[(25.74±2.03)、(26.23±1.66)分],差异均有统计学意义(P<0.05)。结论 右美托咪定联合目标导向液体治疗能够改善老年髋部骨折手术患者脑组织氧代谢,减小术中血压及心率波动,降低术后低血压发生率,有助于促进患者术后认知功能恢复。Objective To explore the effect of dexmedetomidine combined with target-oriented fluid therapy on brain tissue oxygen metabolism and postoperative recovery in elderly patients with hip fracture surgery.Methods A total of 120 elderly patients with hip fracture admitted to Qinhuangdao First Hospital from May 2019 to May 2022 were divided into group A and group B according to the random number table,with 60 patients in each group.Both groups were given dexmedetomidine pump injection 10 minutes before operation,group A was given routine fluid infusion during operation,and group B was given target-oriented fluid therapy.The brain tissue oxygen metabolism[left and right regional cerebral oxygen saturation],blood pressure level,heart rate level at preoperative(T_(0)),subarachnoid block for 5 minutes(T_(1)),and surgery for 30 minutes(T_(2)),intraoperative hypotension and postoperative cognitive function recovery were observed in the two groups.Results There was no statistically significant difference in left rScO_(2),right rScO_(2),MAP,and heart rate between the two groups of patients with T_(0)(P>0.05);the left rScO_(2) of T_(1) and T_(2) in group B were(68.41±4.76)%and(66.18±3.99)%,respectively,while the right rScO_(2) of T_(1) and T_(2) were(67.58±4.41)%and(65.17±3.85)%,respectively,which were higher than those of group A[(65.53±5.05)%,(62.15±4.02)%and(64.36±4.10)%,(61.09±3.96)%],and the differences were statistically significant(P<0.05).The levels of MAP at T_(1) and T_(2) in group B were(95.97±5.16),(95.44±4.22)mmHg,and the heart rate levels were(82.95±4.63),(85.40±4.75)beats/min,respectively,which were higher than those in group A[MAP:(93.65±6.77),(92.15±4.10)mmHg;heart rate:(79.95±4.74),(82.36±5.10)beats/min],the incidence of intraoperative hypotension in group B was 1.67%,which was lower than that in group A(11.67%),and the differences were statistically significant(P<0.05).The scores of mini-mental state examination(MMSE)in group B were(26.81±1.53)and(27.08±1.11)points,respectively,which were h

关 键 词：髋部骨折 右美托咪定 目标导向液体 脑组织氧代谢 

分 类 号：R614[医药卫生—麻醉学]