右美托咪啶联合超声引导下神经阻滞在合并基础疾病的老年患者开放性腹股沟疝手术中的应用

Application of dexmedetomidine combined with ultrasound-guided nerve block in open inguinal hernia surgery in elderly patients with underlying diseases

目的评价右美托咪啶镇静联合超声引导下髂腹股沟、髂腹下神经阻滞在合并基础疾病的老年患者开放性腹股沟疝手术中的安全性、有效性与舒适性。方法选择拟行开放性腹股沟疝手术且有基础疾病的老年患者40例。随机数字表法分为A、B两组,A组为单纯神经阻滞组,B组为右美托咪啶镇静联合神经阻滞组。观察记录两组患者入手术室(T0)、麻醉穿刺时(T1)、麻醉后15 min(T2)、手术切皮时(T3)、游离疝囊时(T4)、手术结束时(T5)等各时间点的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)、Ramsay镇静评分、视觉模拟评分(VAS);评价术中麻醉效果,比较两组患者满意率、体动、心动过缓及呼吸抑制发生率,观察舒芬太尼追加、利多卡因使用情况及不良反应发生情况。结果 A、B两组患者各时点的SpO2比较差异无统计学意义(P> 0. 05);两组患者T0时间点的HR、MAP、Ramsay镇静评分比较差异无统计学意义(P> 0. 05);B组患者T1~T5时的HR、MAP均低于A组,Ramsay评分均高于A组,差异有统计学意义(P <0. 05);B组患者T1、T3、T4、T5时VAS均低于A组,差异有统计学意义(P <0. 05);B组患者麻醉效果优良率高于A组,麻醉穿刺时利多卡因穿刺点局麻、术中需要追加舒芬太尼的例数及体动发生率均少于A组,患者整体满意率高于A组,差异均有统计学意义(P <0. 05)。两组心动过缓的发生率比较差异无统计学意义(P>0. 05)。结论在合并基础疾病的老年患者开放性腹股沟疝手术中,右美托咪啶镇静联合髂腹股沟/髂腹下神经阻滞安全有效,且较单纯的神经阻滞更能提高患者麻醉穿刺时与术中患者的舒适性。

Objective To evaluate the safety,efficacy and comfort of dexmedetomidine sedation combined with ultrasound-guided ilioinguinal and ilioinguinal nerve block in open inguinal hernia surgery for elderly patients with underlying diseases. Methods 40 elderly patients for open inguinal hernia surgery with underlying diseases were selected and randomly divided into group A and group B. Group A recived simple nerve block,while group B recived dextropyrimidine sedation combined with nerve block. The heart rate( HR),mean arterial pressure( MAP),SpO2,Ramsay sedation score and visual analogue score( VAS) at T0( entering operating room),T1( anesthesia puncture),T2( 15 min after anesthesia),T3( surgical incision),T4( hernia sac free),T5( operation ending) in both two groups were recorded,and the intraoperative anesthesia effect were evaluated. The satisfaction rate,incidence of bradycardia,bradycardia and respiratory depression were compared between the two groups;and observed the sufentanil using,lidocaine using and the occurrence of adverse reactions. Results There was no significant difference of SpO2 at each time point between the two groups( P > 0. 05);HR,MAP and Ramsay sedation scores at T0 between the two groups had no significant difference( P > 0. 05);compared with group A,HR,MAP and Ramsay scores at T1-T5 in group B decreased and Ramsay scores increased,while VAS at T1,T3,T4 and T5 in group B were lower( P < 0. 05);in group B,local anesthesia with lidocaine at puncture point,intraoperative sufentanil and body movement were significantly reduced,and the overall satisfaction rate of patients was high( P < 0. 05). There were no obvious adverse reactions in both groups. Conclusions Dexmedetomidine sedation combined with ilioinguinal/iliohypogastric nerve block is safe and effective in elderly patients with open hernia surgery combined with basic diseases,and it can improve the comfort of patients during anesthesia puncture and operation more than simple nerve block.