盐酸右美托咪定在膝关节镜手术腰硬联合麻醉中的安全性及VAS和Ramsay评分影响分析

Safety of dexmedetomidine hydrochloride in combined spinal and epidural anesthesia for knee arthroscopic surgery and the influence of vas and Ramsay scores

目的探讨和分析盐酸右美托咪定在膝关节镜手术腰硬联合麻醉中的安全性及VAS和Ramsay评分影响。方法选取2018年1月至2019年10月于本院行膝关节镜手术患者102例,按照交叉双盲法分为两组,各51例。对照组患者实施腰硬联合麻醉,观察组患者在对照组基础上联合给予盐酸右美托咪定静脉泵注。比较两组患者术后VAS评分、Ramsay评分及不良反应发生率;比较两组T1、T2、T3等时间段HR、SpO2、MAP等血流动力学指标水平变化;比较两组麻醉维持期和苏醒期Cor、E、Flns、HOMA-IR等应激指标水平;比较两组术前术后IFN-γ、TNF-α、IL-6、IL-8等炎性因子指标水平。结果术后,观察组VAS、Ramsay评分及不良反应发生率等临床指标水平均优于对照组,差异有统计学意义(P<0.05)。两组T1期HR、SpO2、MAP等水平比较差异无统计学意义,观察组T2、T3期各项血流动力学指标优于对照组,差异有统计学意义(P<0.05)。两组麻醉维持期Cor、E、Flns、HOMA-IR等水平比较差异无统计学意义,苏醒期观察组各项应激指标水平优于对照组,差异有统计学意义(P<0.05)。术前,两组IFN-γ、TNF-α、IL-6、IL-8等水平比较差异无统计学意义,术后,观察组各项炎性因子水平优于对照组,差异有统计学意义(P<0.05)。结论将盐酸右美托咪定应用于腰硬联合麻醉膝关节镜手术患者,效果良好,可有效减轻疼痛情况,降低不良反应发生风险,同时改善患者血流动力学水平及应激状态,缓解机体炎性应激反应,值得推广。

Objective To investigate and analyze the safety of dexmedetomidine hydrochloride in combined spinal and epidural anesthesia for knee arthroscopy and the influence of vas and Ramsay scores.Methods From January 2018 to October 2019,102 patients with knee arthroscopic surgery were selected and divided into two groups according to the cross double-blind method,with 51 cases in each group.The control group were given combined spinal epidural anesthesia,and 51 patients in the observation group were given dexmedetomidine hydrochloride Intravenous infusion.The VAS score,Ramsay score and the incidence of adverse reactions were compared between the two groups.HR,SpO2,MAP and other hemodynamic indexes in T1,T2,T3 were compared between the two groups.The stress indexes such as Cor,E,Flns,HOMA-IR were compared between the two groups.The levels of IFN-γ,TNF-α,IL-6,IL-8 and other inflammatory factors were compared between the two groups.Results The clinical indexes of vas,Ramsay and the incidence of adverse reactions in the observation group were better than those in the control group(P<0.05).There was no difference in HR,SpO2 and MAP between the two groups.The hemodynamic indexes of T2 and T3 in the observation group were better than those in the control group,and there was difference between the two groups(P<0.05).There was no difference in the levels of Cor,E,Flns,and HOMA-IR between the two groups.The levels of stress indexes in the observation group were better than those in the control group(P<0.05).There was no difference in the levels of IFN-γ,TNF-α,IL-6 and IL-8 between the two groups.The levels of inflammatory factors in the observation group were better than those in the control group(P<0.05).Conclusion Dexmedetomidine hydrochloride was applied to the knee arthroscopic surgery patients under the combined spinal and epidural anesthesia.It was found that the effect was good,and it could effectively reduce the pain,reduce the risk of adverse reactions,improve the hemodynamic level and stress state of patients,and alleviate the inflammatory stress response of the body.It is worth popularizing.