氢吗啡酮复合右美托咪定硬膜外注射对老年全髋关节置换术术后镇痛的效果

Analgesic effect of epidural injection of hydromorphone combined with dexmedetomidine in elderly patients after total hip replacement

目的观察氢吗啡酮复合右美托咪定硬膜外注射对老年全髋关节置换术术后镇痛的效果。方法将78例全髋关节置换术患者随机分为研究组和对照组,每组39例。对照组术毕硬膜外注射氢吗啡酮0.3 mg,研究组依次注射右美托咪定0.5μg/kg及氢吗啡酮0.3 mg。2组术后均采用舒芬太尼静脉自控镇痛。比较2组术后1 h(T1)、4 h(T2)、12 h(T3)、24 h(T4)视觉模拟评分法(VAS)评分、Ramsay镇静评分、心率(HR)、平均动脉压(MAP)及血氧饱和度(SpO2),记录舒芬太尼消耗量及不良反应的发生情况。结果研究组静息和运动状态下T3、T4时点的VAS评分及Ramsay评分均低于对照组,差异有统计学意义(P <0.05);研究组T4时点Ramsay评分低于T1,差异有统计学意义(P <0.05)。研究组T2~T4时点HR及T1~T3时点MAP低于对照组,差异有统计学意义(P <0.05);研究组T2~T4时点HR低于T1时点,对照组T2~T4时点MAP低于T1时点,差异有统计学意义(P <0.05)。研究组舒芬太尼消耗量少于对照组,差异有统计学意义(P <0.05)。2组不良反应比较,差异无统计学意义(P> 0.05)。结论氢吗啡酮复合右美托咪定硬膜外注射对老年全髋关节置换术后镇痛效果显著,可稳定血流动力学指标,利于术后恢复。

Objective To observe the analgesic effect of epidural injection of hydromorphone combined with dexmedetomidine in elderly patients after total hip arthroplasty.Methods Seventy-eight patients undergoing total hip arthroplasty were randomly divided into study group and control group,with 39 cases in each group.The control group was given epidural injection of 0.3 mg hydromorphone after the operation,and the study group was sequentially injected with dexmedetomidine 0.5μg/kg and hydromorphone 0.3 mg.Intravenous controlled analgesia by sufentanil was used in both groups.At 1,4,12,24 h(T 1,T 2,T 3,T 4)after operation,Visual Analogue Scale(VAS)scores,Ramsay sedation score,heart rate(HR),mean arterial pressure(MAP)and blood oxygen saturation(SpO 2)of the two groups were compared.The sufentanil consumption dosage and adverse reactions were recorded.Results The VAS scores and Ramsay scores at T 3 and T 4 of the study group were significantly lower than those of the control group at rest and exercise(P<0.05).The Ramsay score at T 4 of the study group was significantly lower than that of T 1(P<0.05).HR at T 2 to T 4 and MAP at T 1 to T 3 in the study group were significantly lower than those in the control group(P<0.05).Compared with T 1,the study group had decreased HR at T 2 to T 4,and the control group had decreased MAP at T 2 to T 4(P<0.05).The consumption of sufentanil in the study group was significantly less than that in the control group(P<0.05).There was no difference in adverse reactions between the two groups(P>0.05).Conclusion The epidural injection of hydromorphone combined with dexmedetomidine has a significant analgesic effect after total hip arthroplasty in the elderly,and has the functions of stabilizing hemodynamics and benefiting postoperative recovery.