右美托咪定改善全身麻醉下老年全膝关节置换术患者术后苏醒期疼痛与躁动效果评价

Effect of Dexmedetomidine on Improving Pain and Agitation During Awakening Period in Elderly Patients After Total Knee Arthroplasty Under General Anesthesia

目的探讨右美托咪定改善全身麻醉(简称全麻)下老年全膝关节置换术(TKA)患者术后苏醒期疼痛与躁动程度的效果。方法选取泸州市中医医院2017年3月至2019年3月收治的全麻下老年TKA患者100例,按随机数字表法分为观察组与对照组,各50例。观察组患者术前使用微泵缓慢(15 min)静脉注射盐酸右美托咪定注射液0.50μg/kg,对照组患者术前缓慢注射等体积的0.9%氯化钠注射液。结果用药后,两组患者的心率(HR)、平均动脉压(MAP)、血氧饱和度(Sp O2)均明显改善(P<0.05),且观察组患者的HR,MAP均明显低于对照组(P<0.05);苏醒时,两组患者的皮质醇(Cor)、血糖(Glu)水平明显低于手术结束时(P<0.05),且观察组均明显低于观察组(P<0.05);两组患者手术时间、自主呼吸时间与睁眼时间相当(P>0.05);观察组患者的视觉模拟(VAS)评分为(1.10±0.22)分,镇静-躁动(SAS)评分为(3.39±0.65)分,分别低于对照组的(3.05±0.24)分和(4.23±0.49)分(P<0.05);SAS>5分的患者,观察组0例,明显少于对照组的5例(P<0.05)。结论右美托咪定对全麻下老年TKA术后患者苏醒期的疼痛与躁动有一定缓解作用。

Objective To investigate the effect of dexmedetomidine on improving the pain and agitation during awakening period in elderly patients after total knee arthroplasty(TKA)under general anesthesia.Methods Totally 100 elderly patients during awakening period underwent TKA under general anesthesia admitted to Luzhou Hospital of Traditional Chinese Medicine from March 2017 to March 2019 were selected and divided into the observation group and the control group according to the random number table method,50 cases in each group.Before surgery,the patients in the observation group were slowly given 0.50μg/kg Dexmedetomidine Hydrochloride Injection by syringe pumps,while the patients in the control group was slowly injected with 0.9%Sodium Chloride Injection.Results After medication,the heart rate(HR),mean arterial pressure(MAP)and oxygen saturation(Sp O2)in the two groups were significantly improved(P<0.05),and the HR and MAP in the observation group were significantly lower than those in the control group(P<0.05).At the time of waking,the levels of cortisol(Cor)and blood glucose(Glu)in the two groups were significantly lower than those at the end of the operation(P<0.05),and the levels in the observation group were significantly lower than those in the control group(P<0.05).The operation time,spontaneous breathing time and eye opening time in the two groups were similar(P>0.05).The visual analog scale(VAS)score and sedative-agitation scale(SAS)score in the observation group were(1.10±0.22)points and(3.39±0.65)points,which were significantly lower than(3.05±0.24)points and(4.23±0.49)points in the control group(P<0.05).There were 0 case with SAS>5 points in the observation group,which was significantly less than 5 cases in the control group(P<0.05).Conclusion Dexmedetomidine can relieve the pain and agitation during awakening period in elderly patients after TKA under general anesthesia.