右美托咪定两种麻醉方式用于下肢骨折手术麻醉的效果及安全性比较

Effect and safety of two anesthetic techniques in using dexmedetomidine in lower limb fracture surgery

目的对右美托咪定两种麻醉方式用于下肢骨折手术麻醉的效果及安全性进行比较。方法选取2013年6月至2015年6月我院采用手术治疗的下肢骨折患者117例为研究对象,随机分为研究1组和研究2组,分别予以腰丛-坐骨神经阻滞及腰硬联合麻醉。比较两组麻醉效果、安全性、血压、心率及血清血管内皮生长因子(VEGF)水平等。结果研究1组的麻醉显效率、成功率均高于研究2组(67.8%vs.62.1,94.9%vs.87.9%,P<0.05),不良反应发生率低于研究2组(18.6%vs.29.3%,P<0.05)。研究1组术后24h的血压高于研究2组[(119.8±8.9)mm Hg vs.(113.5±9.4)mm Hg,(64.5±7.6)mm Hg vs.(59.8±6.9)mm Hg,P<0.05],心率低于研究2组[(69.4±8.6)次/min vs.(73.6±8.5)次/min],VEGF高于研究2组[(464.5±93.6)pg/mL vs.(386.8±89.5)pg/mL,P<0.05]。结论右美托咪定腰丛-坐骨神经阻滞麻醉用于下肢骨折手术麻醉,与腰硬联合麻醉相比,具有麻醉效果好,安全性高,能明显改善VEGF水平,加速骨折愈合等优点。

Objective To observe the effect and safety of two anesthetic techniques of dexmedetomidine during lower limb fracture surgery.Methods Totally 117 patients receiving lower limb fracture surgery in our hospital from June 2013 to June 2015 were included and randomly divided into two groups（study group 1 and study group 2） according to different anesthesia with DEX-lumbar plexus-sciatic nerve block and combined spinal-epidural anesthesia.The blood pressure,heart rate and serum level of vascular endothelial growth factor（VEGF） were compared between the two groups.Results The effective rate and success rate of anesthesia in study group 1 were higher than those of study group 2：（119.8 ± 8.9） mmHg vs.（113.5 ± 9.4） mmHg,（64.5 ± 7.6） mmHgvs.（59.8 ± 6.9） mmHg,P〈0.05）,and the incidence of adverse events in study group 1 was lower than that of study group 2（18.6% vs.29.3%,P〈0.05）.At 24 h after surgery,The status in blood pressure,heart rate and VEGF in study group 1 was superior to study group 2（P〈0.05）.Conclusion Lumbar plexus-sciatic nerve block with DEX has a better effect and safety than combined spinal-epidural anesthesia,it can improve the VEGF level and accelerate the bone fracture healing after surgery.