右美托咪定对老年髋关节置换术患者应激反应及血流动力学的影响

Effects of dexmedetomidine on stress response and hemodynamics in elderly patients with hip replacement

目的探讨右美托咪定术后镇痛对老年髋关节置换术患者应激反应及血流动力学的影响。方法选取2016年9月至2018年2月于山西医科大学第二医院行髋关节置换术的老年患者92例,根据随机数字表法分为实验组和对照组,每组46例。对照组行常规舒芬太尼术后镇痛,实验组在对照组基础上加用右美托咪定,对比两组术后各时间点视觉模拟评分(VAS)、应激反应及血流动力学指标。结果实验组术后1、4、12hVAS评分均低于对照组,差异有统计学意义(P<0.05)。两组患者术后各时间点血浆皮质醇、肾上腺素、去甲肾上腺素水平均高于术前,且实验组改善程度优于对照组,差异有统计学意义(P<0.05)。实验组术后各时间点心率、收缩压、舒张压均低于对照组,差异有统计学意义(P<0.05)。结论美托咪定能够有效提高老年髋关节置换术患者的镇痛效果,减少应激反应并改善血流动力学指标。

Objective To investigate the effects of postoperative analgesia by dexmedetomidine on stress response and hemodynamics in elderly patients with hip replacement.Methods Ninety-two elderly patients who underwent hip replacement in the Second Hospital of Shanxi Medical University from September 2016 to February 2018 were selected.According to the random number table method,patients were divided into experimental group and control group,with 46 cases in each group.Patients in control group were given sufentanil routine postoperative analgesia,and patients in experimental group were given dexmedetomidine on the basis of treatment for control group.The visual analogue scale(VAS)scores,stress response and hemodynamic indexes at each time point after surgery were compared between the two groups.Results VAS scores of experimental group at 1 h,4 h and 12 h after operation were lower than those of control group,and the difference was statistically significant(P<0.05).Compared with before surgery,plasma cortisol,adrenaline and norepinephrine levels were significantly increased at each time point after surgery in the two groups,and the improvement degree of experimental group was better than that of control group,and difference was statistically significant(P<0.05).The heart rate,systolic blood pressure and diastolic blood pressure of experimental group were all lower than those of control group at every postoperative time point,and the difference was statistically significant(P<0.05).Conclusions Metopidine can effectively improve the analgesic effect,reduce the stress response and improve the hemodynamic parameters in elderly patients with hip replacement.