右美托咪定联合局部浸润麻醉用于老年骨质疏松性椎体骨折患者的临床研究  

Clinical trial of dexmedetomidine combined with local infiltration anesthesia on perioperative stress in elderly patients with osteoporotic vertebral fractures

作　　者：韦珊珊[1] 韦宁 黄钰芳 韦登文[1] WEI Shan-shan;WEI Ning;HUANG Yu-fang;WEI Deng-wen(Department of Anesthesiology,Hechi Third People's Hospital,Hechi 547000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]河池市第三人民医院麻醉科,广西壮族自治区河池547000

出　　处：《中国临床药理学杂志》2023年第22期3248-3252,共5页The Chinese Journal of Clinical Pharmacology

基　　金：河池市科学研究与技术开发计划基金资助项目(河科B1717-21)。

摘　　要：目的观察右美托咪定联合局部浸润对老年骨质疏松性椎体骨折(OVF)患者围术期应激和药物不良反应的影响。方法将OVF患者按随机数字表法分为对照组和试验组,2组均进行经皮椎体后凸成形术,1%利多卡因20~30 mL局部浸润麻醉后开始手术。试验组术前10 min静脉泵注右美托咪定0.8μg·kg^(-1),10 min后调整为0.4μg·kg^(-1)·h^(-1)维持至术毕,对照组术前10 min静脉泵注等容量0.9%NaCl注射液至术毕。比较2组患者的入室5 min(T0)、注入局麻药时(T1)、穿刺针到达椎体即刻(T2)、骨水泥注入即刻(T3)、术毕即刻(T4)、术后2 h(T5)5个时间点的血流动力学指标,T0、T1、T2、T3、T4的麻醉效果及T0、T4、T5的围术期应激指标,分析追加药物情况及药物不良反应情况。结果2组T0、T5时的心率、平均动脉压及各时间点的血氧饱和度差异均无统计学意义(均P>0.05)。试验组T1、T2、T3、T4的平均动脉压分别为(90.57±11.51)、(89.68±11.48)、(91.26±8.74)、(88.96±9.84)mmHg,均显著低于对照组的(106.14±8.57)、(109.28±9.34)、(111.42±9.62)、(105.88±8.75)mmHg(均P<0.05)。试验组T1、T2、T3、T4的镇静评分分别为(2.86±0.29)、(2.81±0.36)、(2.73±0.38)、(2.49±0.32)分,均显著高于对照组的(1.81±0.28)、(1.68±0.27)、(1.59±0.30)、(1.64±0.26)分(均P<0.05)。试验组T1、T2、T3、T4的疼痛评分分别为(2.52±0.36)、(2.97±0.28)、(3.69±0.56)、(2.57±0.63)分,显著低于对照组的(3.23±0.30)、(5.16±0.87)、(5.48±1.02)、(3.85±0.79)分(均P<0.05)。试验组T5的血糖、肾上腺素、去甲肾上腺素、皮质醇水平分别为(7.62±0.73)mmol·L^(-1)、(20.23±3.86)pg·mL^(-1)、(413.65±131.38)pg·mL^(-1)和(191.46±26.52)ng·mL^(-1),均显著低于对照组的(8.08±0.78)mmol·L^(-1)、(26.39±4.22)pg·mL^(-1)、(463.41±136.16)pg·mL^(-1)和(219.21±26.54)ng·mL^(-1)(均P<0.05)。试验组药物不良反应发生率与对照组比较差异无统计学意义(15.00%vs.12.50%,P>0.05)。�Objective To observe the effects of dexmedetomidine combined with local infiltration on perioperative stress and adverse drug reactions in elderly patients with osteoporotic vertebral fractures(OVF).Methods Patients with OVF were divided into control group and treatment group according to the random number table method.Percutaneous kyphoplasty was performed in both groups and the surgery was started after local infiltration anesthesia with 1%lidocaine 20-30 m L.Treatment group was injected intravenously with 0.8μg·kg^(-1)dexmedetomidine at 10min before surgery,and adjusted to 0.4μg·kg^(-1)·h^(-1)after 10 min for maintenance anesthesia until the end of surgery,and the control group was intravenously injected 0.9%NaCl at 10 min before surgery until the end of surgery.The hemodynamic indicators at different time points[at 5 min after entry(T0),at the time of local anesthetic injection(T1),at the time of puncture needle arriving at vertebra(T2),at the time of bone cement injection(T3),immediately after the end of surgery(T4),at 2 h after surgery(T5)],anesthetic effect at T0,T1,T2,T3 and T4and perioperative stress indicators at T0,T4 and T5 were compared between the two groups of patients.The differences in additional drugs and adverse drug reactions were analyzed.Results There were no statistically significant differences in heart rate and mean arterial pressure at T0 and T5 and blood oxygen saturation at various time points between the two groups(all P>0.05).The mean arterial pressures at T1,T2,T3 and T4 in treatment group were(90.57±11.51),(89.68±11.48),(91.26±8.74)and(88.96±9.84)mm Hg,significantly lower than those control group,which were(106.14±8.57),(109.28±9.34),(111.42±9.62)and(105.88±8.75)mm Hg(all P<0.05).The sedation scores at T1,T2,T3 and T4 in treatment group with(2.86±0.29),(2.81±0.36),(2.73±0.38)and(2.49±0.32)points,significantly higher than(1.81±0.28),(1.68±0.27),(1.59±0.30)and(1.64±0.26)points in control group(all P<0.05).The pain scores at T1,T2,T3 and T4 in treatment group were

关 键 词：右美托咪定 局部浸润麻醉 老年 骨质疏松性椎体骨折 应激 

分 类 号：R971.2[医药卫生—药品]