右美托咪定联合七氟醚麻醉对老年下肢骨折患者术后认知功能、应激反应及疼痛的影响

Effects of Dexmedetomidine Combined with Sevoflurane on Postoperative Cognitive Function,Stress Response and Pain in Elderly Patients with Lower Limb Fracture

目的 探讨右美托咪定联合七氟醚麻醉对老年下肢骨折患者术后认知功能、应激反应及疼痛的影响。方法 将2015年12月—2017年12月118例于我院行手术治疗的老年下肢骨折患者作为研究对象,根据麻醉药物使用的不同分为观察组( n =62)和对照组( n =56),观察组予右美托咪定联合七氟醚麻醉,对照组予右美托咪定联合丙泊酚麻醉。比较两组术前(T1)、术后6 h(T2)、术后12 h(T3)和术后24 h(T4)时认知功能、应激反应及疼痛情况。结果 对照组T2、T3、T4时简易精神状态量表(mini-Mental state examination, MMSE)评分均低于T1时,观察组T2、T3时MMSE评分较T1时降低,比较差异均有统计学意义( P <0.01);观察组T2、T3和T4时MMSE评分均显著高于对照组( P <0.01)。两组T2、T3和T4时丙二醛(MDA)、活性氧簇(ROS)含量均较T1时升高,且观察组T2、T3和T4时MDA、ROS含量均低于对照组,差异均有统计学意义( P <0.01)。两组T2、T3和T4时视觉模拟评分(visual analogue scale, VAS)均较T1时显著降低,且观察组T2、T3和T4时VAS评分均显著低于对照组,差异均有统计学意义( P <0.01)。结论 右美托咪定联合七氟醚麻醉更有利于保护老年下肢骨折患者术后认知功能,并抑制机体应激反应的产生,可更大程度减轻术后疼痛,可作为老年下肢骨折手术适用的麻醉方案。

Objective To explore the effects of dexmedetomidine combined with sevoflurane on postoperative cognitive function, stress response and pain in elderly patients with lower limb fractures. Methods A total of 118 elderly patients with lower limb fractures who were treated by surgery in our hospital from December 2015 to December 2017 were enrolled. The patients were divided into observation group ( n =62) and control group ( n =56) according to different anesthetics used in surgery. Patients in the observation group were anesthetized with dexmedetomidine combined with sevoflurane, and those in the control group were anesthetized with dexmedetomidine combined with propofol. Cognitive function, stress response and pain were compared between the two groups before surgery (T1), at 6h (T2), 12h (T3) and 24h (T4) after surgery. Results In the control group, the Mini-Mental State Examination (MMSE) scores at T2, T3, and T4 were lower than those at T1. MMSE scores at T2 and T3 were lower than those at T1 in the observation group, and there were significant differences ( P <0.01), and the MMSE scores of the observation group at T2, T3 and T4 were significantly higher than those of the control group ( P <0.01). At T2, T3 and T4, MDA and ROS levels were higher than those at T1, and MDA, and ROS levels were lower in the observation group than in the control group ( P <0.05). Visual analogue scale (VAS) scores at T2, T3 and T4 were significantly lower than those at T1, and VAS score of the observation group at T2, T3 and T4 was significantly lower than that of the control group ( P <0.05). Conclusion Dexmedetomidine combined with sevoflurane is more conducive to protecting the cognitive function of elderly patients with lower limb fracture and inhibiting the generation of stress response. In addition, it can mitigate the postoperative pain of patients to a greater extent, which is, therefore, worthy of being used as one of the anesthesia schemes for elderly patients undergoing lower extremity fracture surgery.