羟考酮联合右美托咪定辅助局部麻醉在老年经皮椎体成形术中麻醉效果及安全性评价  

Anesthetic effect and safety evaluation of oxycodone combined with dexmedetomidine assisted local anesthesia in elderly patients undergoing percutaneous vertebroplasty

作　　者：李秀芳 张喜华 郝泉水 夏瑞[2] LI Xiufang;ZHANG Xihua;HAO Quanshui;XIA Rui(Department of Anesthesiology,Huanggang Central Hospital,Health Science Center of Yangtze University,Huanggang 438000;Department of Anesthesiology,The First Affiliated Hospital of Yangtze University,Jingzhou 434000,China)

机构地区：[1]长江大学医学部,黄冈市中心医院麻醉科,湖北黄冈438000 [2]长江大学附属第一医院麻醉科,湖北荆州434000

出　　处：《麻醉安全与质控》2025年第2期118-122,共5页Perioperative Safety and Quality Assurance

基　　金：湖北省卫生健康委员会科研项目(WJ2021M084、WJ2023M176);湖南省人民医院医联体专项科研基金项目(2022YLT006)。

摘　　要：目的探讨羟考酮与右美托咪定联合局部麻醉在老年经皮椎体成形术中的安全性和有效性。方法选取黄冈市中心医院2023年1月至2024年6月单个椎体骨质疏松压缩性骨折患者120例,年龄65~80岁,BMI 18~30 kg/m^(2),ASA分级Ⅱ或Ⅲ级。采用随机数字表法将患者分为四组:羟考酮联合右美托咪定+局部麻醉组(A组),羟考酮+局部麻醉组(B组),右美托咪定+局部麻醉组(C组),局部麻醉对照组(D组),每组患者30例。记录入室俯卧位前5 min(T_(0))、切皮时刻(T_(1))、穿刺针到达椎体时刻(T_(2))、骨水泥注入扩张时刻(T_(3))、手术结束时刻(T_(4))及出麻醉恢复室前(T_(5))的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、脉搏血氧饱和度(SpO_(2)),疼痛视觉模拟评分(VAS)及镇静Ramsay评分,各组不良反应,如呼吸抑制、循环波动、恶心呕吐及术中体动等。结果与D组比较,A、B、C组T_(1)、T_(2)、T_(3)、T_(4)各时点HR、MAP差异有统计学意义(P<0.05);A、B、C组T_(1)、T_(2)、T_(3)、T_(4)各时点VAS评分及Ramsay评分,差异有统计学意义(P<0.05)。与D组比较,A组术中躁动、心律失常、恶心呕吐等不良反应发生率(13.3%vs 46.7%),差异有统计学意义(P<0.05),A、B、C三组之间不良反应发生率差异无统计学意义(P>0.05)。结论羟考酮复合右美托咪定有显著镇痛、镇静效果,且不良反应发生率低,具有较高临床应用价值。Objective To investigate the safety and efficacy of oxycodone combined with dexmedetomidine assisted local anesthesia in elderly patients undergoing percutaneous vertebroplasty.Methods A total of 120 patients with single vertebral osteoporosis compression fracture,aged 65-80 years,BMI 18-30 kg/m^(2),ASAⅡ or Ⅲ,from January 2023 to June 2024 were selected from Huanggang Central Hospital.Patients were divided into four groups,oxycodone combined with dexmedetomidine+local anesthesia group(group A,n=30),oxycodone+local anesthesia group(group B,n=30),dexmedetomidine+local anesthesia group(group C,n=30)and local anesthesia control group(group D,n=30),according to random number table method.Heart rate(HR),mean arterial pressure(MAP),respiratory rate(RR)and pulse oxygen saturation(SpO_(2))were recorded at 5 min before being in prone position(T_(0)),the time of skin resection(T_(1)),the time when puncture needle reached vertebra(T_(2)),the time when bone cement was injected and expanded(T_(3)),the time after surgery(T_(4)),and the time before leaving the anesthesia recovery room(T_(5)).Pain visual analogue score(VAS),Ramsay score,and adverse reactions in each group,such as respiratory depression,circulatory fluctuation,nausea and vomiting,and intraoperative body movement were also recorded at each time point.Results Compared with group D,there were significant differences in HR and MAP at T_(1),T_(2),T_(3) and T_(4) in group A,group B and group C(P<0.05).VAS scores and Ramsay scores at T_(1),T_(2),T_(3) and T_(4) in group A,group B and group C were significantly different,with statistical significance(P<0.05).Compared with group D,the incidence of intraoperative adverse reactions such as agitation,arrhythmia,nausea and vomiting in group A(13.3%vs 46.7%)had statistical significance(P<0.05),while the incidence of adverse reactions among group A,group B and group C had no statistical significance(P>0.05).Conclusion Oxycodone combined with dexmedetomidine has significant analgesic and sedative effects,and the incidence of

关 键 词：羟考酮 右美托咪定 经皮椎体成形术 

分 类 号：R61[医药卫生—外科学]