右美托咪定联合股神经阻滞对下肢骨折手术全身麻醉患者止血带反应的影响  

Effect of Dexmedetomidine Combined with Femoral Nerve Block on Tourniquet Reaction in Patients Undergoing General Anesthesia for Lower Limb Fracture Surgery

作　　者：丁冰倩 王宗悦 徐佳顺 王培霖 宋哲明 DING Bingqian;WANG Zongyue;XU Jiashun;WANG Peilin;SONG Zheming(Department of Anesthesiology,905 Hospital of People's Liberation Army Navy,Shanghai 200000,China)

机构地区：[1]中国人民解放军海军第九〇五医院麻醉科,上海200000

出　　处：《转化医学杂志》2024年第5期797-800,805,共5页Translational Medicine Journal

基　　金：上海市自然科学基金(22ZR1476600)。

摘　　要：目的探讨在股神经阻滞基础上应用右美托咪定对下肢骨折手术全身麻醉患者止血带反应的影响。方法选取2021年1月至2024年3月就诊于中国人民解放军海军第九〇五医院的下肢骨折且行手术治疗的患者120例作为研究对象。采用随机数字表法将纳入患者分为对照组和试验组,各60例。对照组患者接受股神经阻滞治疗,试验组患者接受股神经阻滞和右美托咪定治疗,比较2组患者氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]、血流动力学指标[心率(HR)、平均动脉压(MAP)]、视觉疼痛模拟评分(VAS)及不良反应。结果2组T6时间点(止血带释放后15 min)SOD较T0时间点(神经阻滞前)降低,MDA较T0时间点升高(P<0.05);试验组T6时间点SOD高于对照组,MDA则低于对照组(P<0.05)。2组T2~T5时间点(止血带充气后30~90 min)HR、MAP均逐渐升高,且试验组低于对照组(P<0.05)。术后12、24、48 h 2组患者VAS评分均呈先升高后降低的趋势,试验组各时间点VAS评分均低于对照组(P<0.05);2组患者不良反应发生率相近(P>0.05)。结论下肢骨折手术全身麻醉患者在股神经阻滞基础上应用右美托咪定,可有效地缓解止血带反应,且安全性良好。Objective To investigate the effect of dexmedetomidine on tourniquet reaction in patients undergoing general anesthesia for lower limb fracture surgery based on femoral nerve block.Methods The study subjects were 120 patients with lower limb fractures who underwent treatment surgically from January 2021 to March 2024 in the 905 Hospital of People's Liberation Army Navy.The patients were divided into two groups by random number table method,with 60 patients in the control group receiving femoral nerve block,and 60 patients in the experimental group receiving femoral nerve block and dexmedetomidine.The oxidative stress indexes[malondialdehyde(MDA),superoxide dismutase(SOD)],hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)],visual pain simulation score(VAS)and adverse reactions were compared between the two groups.Results SOD decreased and MDA increased at T6 time point(15 min after tourniquet release)compared to T0 time point(before nerve block)in both groups(P<0.05);At T6 time point,the SOD level in the experimental group was higher than those of the control group,while the MDA level was lower than those of the control group(P<0.05).HR and MAP at T2-T5 time points(30-90 min after tourniquet inflation)for both groups gradually increased,and the values for the experimental group were lower than those of the control group(P<0.05).The VAS scores of the two groups increased first and then decreased at 12 hours,24 hours and 48 hours after surgery,and the VAS scores of the experimental group were lower than the control group at each time point(P<0.05).The incidence of adverse reactions was similar between the two groups of patients(P>0.05).Conclusion The application of dexmedetomidine combined with femoral nerve block in patients undergoing general anesthesia for lower limb fracture surgery can effectively alleviate tourniquet reactions and has good safety.

关 键 词：下肢骨折 全身麻醉 右美托咪定 股神经阻滞 止血带反应 

分 类 号：R683.42[医药卫生—骨科学]