右美托咪定联合硬膜外麻醉在老年高血压患者全髋关节置换术中的效果评价

Effect of dexmedetomidine combined with epidural anesthesia on total hip arthroplasty in elderly patients with hypertension

目的观察静脉辅助应用右美托咪定联合硬膜外麻醉在老年高血压患者全髋关节置换术中的临床效果。方法选取笔者所在医院2017年6月—2019年6月骨科收治的行全髋关节置换术的老年患者120例(年龄>65周岁,临床确诊为高血压),使用随机数字表法将患者随机分为三组:单纯硬膜外麻醉组(C组)、0.2μg/kg·h右美托咪定+硬膜外麻醉组(D1组)、0.4μg/kg·h右美托咪定+硬膜外麻醉组(D2组)。收集患者的一般情况和手术情况,比较三组在麻醉前(T0)、置管后(T1)、给局麻药后5 min(T2)、手术开始后(T3)、手术结束时(T4)及术后24 h(T5)五个时间点的SBP、DBP、MAP、HR及Ramesay评分,分析患者神经阻滞的效果及围术期不良反应的发生率,并观察围术期患者VAS评分和术后吗啡消耗量。结果三组患者一般情况和手术情况无统计学差异,在T3时D1、D2组SBP、DBP、HR均显著低于C组(P<0.05),且D2组显著低于D1组(P<0.05);在T4时D2组SBP、DBP显著低于C组(P<0.05),且D2组血流动力学指标在不同时间点变化较小。D2组Ramesay镇静评分在T2、T3、T4均显著高于C组(P<0.05),同时感觉、运动阻滞起效时间明显短于C、D1组,持续时间显著长于C、D1组(P<0.05),而D1组感觉阻滞起效时间短于C组,感觉、运动阻滞持续时间明显长于C组(P<0.05)。三组患者心动过缓、心动过速、呼吸抑制、恶心、呕吐、躁动、低血压等发生率并无统计学差异。D2组在T3、T4、T5时间点的VAS评分显著低于C组(P<0.05),同时D1、D2组24 h吗啡消耗量明显少于C组(P<0.05)。结论右美托咪定复合硬膜外麻醉能够维持老年高血压患者全髋关节置换术中血流动力学稳定并获得较好的神经阻滞效果,增强镇痛效果并减少术后镇痛药物的使用量,更加安全有效,但并不能改善不良反应的发生率。

Objective To observe the effect of intravenous dexmedetomidine(Dex)combined with epidural anesthesia on total hip arthroplasty in elderly patients with hypertension.Methods 120 elderly patients with hypertension undergwent total hip arthroplasty from June 2017 to June 2019 in the hospital were included and randomly divided into three groups:epidural anesthesia group(C),0.2μg/kg·h Dex combined with epidural anesthesia group(D1)and 0.4μg/kg·h Dex combined with epidural anesthesia group(D2).General data and operation condition were collected,and SBP,DBP,MAP,HR,Ramesay scores at these time-points of pre-anesthesia(T0),post-catheter(T1),post-anesthetic drugs(T2),intraoperative period(T3),post-operation(T4)and 24h after operation were analyzed.And,neurological blockade efficiency,adverse events,VAS scores and morphine consumption in perioperative period were compared.Results Patients in three groups showed no significant differences in general data and operation condition.SBP,DBP and HR in Group D1 and D2 were significantly lower than that in Group C at T3,and Group D2 was significantly lower than that in Group D1 at T3.SBP and DBP in Group D2 were significantly lower than that in Group C at T4,and the hemodynamic parameters in Group D2 changed slightly at different time points.The Ramesay sedation scores in Group D2 were significantly higher in T2,T3 and T4 than that in Group C.The onset time of sensory and motor block in Group D2 were significantly shorter than that in Group C and D1,while the duration was significantly longer.Moreover,the onset time of sensory block in Group D1 was shorter than that in Group C,while the duration of sensory and motor block was significantly longer.The incidence of bradycardia,tachycardia,respiratory depression,nausea,vomiting,agitation and hypotension in three groups showed no significant difference.The VAS scores in Group D2 were significantly lower than that in Group C at T3,T4 and T5,and the morphine consumption in 24h in Group D1 and D2 was significantly lower than that in Group C.Conclusions Intravenous Dex combined with epidural anesthesia can maintain hemodynamic stability,acquire better neurological blockade and analgesic efficiency during total hip arthroplasty in elderly patients with hypertension.