罗哌卡因复合右美托咪定蛛网膜下腔阻滞麻醉应用于老年下肢骨科手术患者的效果  

Effect of ropivacaine combined with dexmedetomidine subarachnoid block anesthesia on elderly patients undergoing lower extremity orthopedic surgery

作　　者：王进华 滕云娟 Wang Jinhua;Teng Yunjuan(Department of Anesthesiology,Tianjin Binhai New Area Hospital of Traditional Chinese Medicine,Tianjin 300451,China)

机构地区：[1]天津市滨海新区中医医院麻醉科,天津300451

出　　处：《中国药物与临床》2024年第7期448-451,共4页Chinese Remedies & Clinics

摘　　要：目的分析老年下肢骨折患者实施罗哌卡因复合右美托咪定蛛网膜下腔阻滞麻醉方案的效果。方法纳入下肢骨科手术老年患者90例,均于2021年1月至2022年12月在天津市滨海新区中医医院实施手术方案,根据治疗方法为45例观察组和45例对照组。观察组应用罗哌卡因+右美托咪定蛛网膜下腔阻滞麻醉处理,对照组应用罗哌卡因+舒芬太尼蛛网膜下腔阻滞麻醉处理,比较2组患者在麻醉前、麻醉后各时间点的心率、平均动脉压(MAP)、血氧饱和度(SpO2)等血流动力学指标变化情况,运动神经阻滞、感觉神经阻滞起效与维持时间,首次使用镇痛药物的剂量、次数、舒适度情况,不同时段神经元特异性烯醇化酶(NSE)与中枢神经特异蛋白(S100-β)水平以及发生头晕、尿潴留、恶心呕吐、皮肤瘙痒的不良反应发生率。结果2组血流动力学指标变化比较差异无统计学意义(P>0.05)。相比于对照组,感觉运动阻滞起效时间观察组更早,持续时间长,使用体况评分(BCS)高,使用镇痛药物次数少,不良反应发生率更低(P<0.05),2组患者在麻醉前、手术30 min以及手术结束时的NSE与S100-β水平比较差异无统计学意义(P>0.05)。结论老年下肢骨科手术患者应用罗哌卡因复合右美托咪定蛛网膜下腔阻滞麻醉,患者血流动力学指标平稳,比复合舒芬太尼麻醉效果更显著,安全性更高,具有很高的应用价值。Objective To investigate the effect and influence of ropivacaine combined with dexmedetomi-dine subarachnoid block anesthesia in elderly patients undergoing lower extremity orthopedic surgery.Methods A total of 90 elderly patients were selected,all of whom underwent lower extremity orthopedic surgery in Tianjin Binhai New Area Hospital of Traditional Chinese Medicine,from January 2021 to December 2022.They were randomly divided into a control group(45 cases)and an observation group(45 cases)according to treatment meth-ods.The patients in the observation group were treated with ropivacaine plus dexmedetomidine for subarachnoid block anesthesia,while the patients in the control group were treated with ropivacaine plus sufentanil for sub-arachnoid block anesthesia.The hemodynamic changes including heart rate(HR),mean arterial pressure(MAP),and oxygen saturation(SpO2)before anesthesia and at various time points during anesthesia were compared be-tween the two groups.And the onset and duration of motor nerve block and sensory nerve block,the dose and fre-quency of the first use of analgesic drugs,comfort level,the levels of neuron-specific enolase(NSE)and S100-βcentral nervous system-specific protein at different time periods,and the incidence of adverse reactions such as dizziness,urinary retention,nausea and vomiting,and skin itching were compared between the two groups.Results There were no significant differences in hemodynamic indexes between the two groups(P>0.05).Compared with the control group,the observation group had less data on the onset time for sensorimotor block,a longer duration,a higher BCS score,fewer uses of analgesic drugs,and a lower incidence of adverse reactions(P<0.05).There was no statistical significance in the levels of NSE and S100-βbetween the two groups before anesthesia,30 min after surgery and at the end of surgery(P>0.05).Conclusion Ropivacaine combined with dexmedetomidine in sub-arachnoid block anesthesia for elderly patients undergoing lower extremity orthopedic surgery has stable

关 键 词：罗哌卡因 右美托咪啶 麻醉 脊椎 老年人 血流动力学 麻醉效果 

分 类 号：R614[医药卫生—麻醉学]