右美托咪定在老年髋关节置换术后的应用效果分析

Effect analysis of dexmedetomidine after hip replacement in elderly patients

目的探讨右美托咪定辅助自控镇痛用于老年髋关节置换术后的镇痛效果和对睡眠质量的影响。方法选择2017年2月至2019年12月在马鞍山市人民医院超声引导腹股沟上髂筋膜间隙阻滞联合全身麻醉下行髋关节置换术的60例老年患者,采用随机数字表法,分为对照组(舒芬太尼1.5μg/kg)与试验组(舒芬太尼1.5μg/kg+右美托咪定1.5μg/kg),每组30例。观察比较两组患者术后情况,并进行统计学分析。结果与对照组比较,试验组患者术后同一时间段NRS评分低,Ramsay镇静评分高,差异均有统计学意义(P<0.05);术后不同时间的NRS评分随时间推移有升高趋势,Ramsay镇静评分随时间推移有下降趋势,差异均有统计学意义(P<0.05);两组患者术后睡眠评分比较,差异有统计学意义(P<0.05)。术后睡眠评分随时间的推移有下降的趋势,术前及术后不同时间的睡眠评分差异有统计学意义(P<0.05)。试验组患者首次下床活动时间为(27.23±8.54)h,术后补救舒芬太静脉镇痛使用量和恶心、呕吐等不良反应发生率明显降低,均优于对照组,差异有统计学意义(P<0.05)。结论右美托咪定多模式镇痛应用于老年髋关节置换术后的镇痛效果显著,减少患者不良反应发生率,明显改善患者术后睡眠质量,提高满意度。

Objective To investigate the analgesic effect and sleep quality of dexmedetomidine assisted patient-controlled analgesia in elderly patients after hip replacement.Methods Sixty patients with hip replacement under ultrasound-guided superior inguinal fascia space block combined with general anesthesia were selected in Maanshan People’s Hospital from February 2017 to December 2019,and divided into control group(sufentanil 1.5μg/kg)and experimental group(sufentanil 1.5μg/kg+dexmedetomidine 1.5μg/kg),with 30 patients in each group.The postoperative conditions of the two groups were observed and recorded,and the statistical analysis was conducted.Results Compared with control group,the NRS score of experimental group was lower and Ramsay Sedation score was higher at the same time after operation(P<0.05).The NRS score of different time after operation tended to increase with time,Ramsay Sedation score decreased with time,and the differences were statistically significant(P<0.05);the difference in sleep score between the two groups was statistically significant(P<0.05).The sleep score decreased with time,and there was significant difference in sleep score before and after operation(P<0.05).The first ambulation time of patients in experimental group was(27.23±8.54)h,the use of postoperative rescue sufentanil for intravenous analgesia and the incidence of nausea,vomiting and other adverse reactions were significantly lower than those in control group,and the difference was statistically significant(P<0.05).Conclusions Dexmedetomidine multimodal analgesia in elderly patients after hip arthroplasty has significant analgesic effect,which can reduce the incidence of adverse reactionsand markedly improve the quality of sleep and satisfaction.