右美托咪定在老年髋关节置换术椎管内麻醉中的应用价值

Application value of dexmedetomidine in intraspinal anesthesia for hip replacement in the elderly

目的探讨右美托咪定在老年髋关节置换术椎管内麻醉中的应用价值。方法选取该院行髋关节置换术的120例老年患者为研究对象,随机分为研究组和对照组,每组60例。两组患者均采用椎管内麻醉(脊椎麻醉联合硬膜外麻醉),研究组于术前20 min及术中静脉泵注右美托咪定。比较两组术后认知功能障碍(POCD)发生率;比较两组术前1 d、术后3 d及术后6 d的中枢神经特异性蛋白(S100β)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平及简易精神状态量表(MMSE)评分;比较两组麻醉前(T1)、手术开始后30 min(T2)、手术结束(T3)3个时间点的心率(HR)、平均动脉压(MAP)水平及不良反应发生情况。结果研究组POCD发生率为8.3%,低于对照组的16.7%(P<0.05)。两组术后3、6 d的MMSE评分低于术前1 d,S100β、TNF-α、IL-6水平高于术前1 d,差异均有统计学意义(P<0.05)。研究组术后3、6 d的MMSE评分高于对照组,S100β、TNF-α、IL-6水平低于对照组,差异均有统计学意义(P<0.05)。研究组T2、T3时间点的HR、MAP水平均低于对照组(P<0.05)。研究组的总不良反应发生率为60.0%,低于对照组的80.0%(P<0.05)。结论对于椎管内麻醉下行髋关节置换术的老年患者,术前及术中使用适量右美托咪定能提高麻醉效果,降低炎性反应水平,维持血流动力学稳定,降低POCD发生率。

Objective To explore the application value of dexmedetomidine in intraspinal anesthesia for hip replacement in the elderly.Methods A total of 120 elderly patients underwent hip replacement in the hospital were selected as the research objects,and they were randomly divided into the study group and the control group,each with 60 cases.The two groups were given intraspinal anesthesia(spinal anesthesia combined with epidural anesthesia),and the study group was given intravenous dexmedetomidine 20 minutes before operation and during operation.The incidence of postoperative cognitive dysfunction(POCD)was compared between the two groups.The levels of central nerve specific protein(S100β),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and mini mental state scale(MMSE)scores were compared between the two groups at 1 day before operation,3 day after operation and 6 day after operation.The heart rate(HR),mean arterial pressure(MAP)levels and the occurrence of adverse reactions were compared between the two groups before anesthesia(T1),30 minutes after the start of the operation(T2)and the end of the operation(T3).Results The incidence of POCD in the study group was 8.3%,which was lower than 16.7%in the control group(P<0.05).The MMSE scores in the two groups at 3 and 6 days after operation was lower than that at 1 day before operation,and the levels of S100β,TNF-αand IL-6 were higher than those at 1 day before operation,the difference were statistically significant(P<0.05).The MMSE scores in the study group were higher than those in the control group at 3 and 6 days after operation,and the levels of S100β,TNF-αand IL-6 were lower than those in the control group at 3 and 6 days after operation,the differences were statistically significant(P<0.05).The HR and MAP levels at T2 and T3 in the study group were lower than those in the control group(P<0.05).The total adverse reaction rate in the study group was 60.0%,which was lower than 80.0%in the control group(P<0.05).Conclusion For elderly patients undergoing hip replacement under intraspinal anesthesia,preoperative and intraoperative use of dexmedetomidine can promote the anesthetic effect,reduce the level of inflammatory response,maintain hemodynamic stability,and reduce the incidence of POCD.