右美托咪定与罗哌卡因腰硬联合麻醉对老年下肢骨折患者围术期血流动力学、麻醉恢复质量及镇痛效果的影响

Influences of combined spinal-epidural anesthesia with dexmedetomidine and ropivacaine on perioperative hemodynamics,anesthesia recovery quality and analgesic effect in elderly patients undergoing lower limb fracture surgery

目的:探讨右美托咪定与罗哌卡因腰硬联合麻醉对老年下肢骨折患者围术期血流动力学、麻醉恢复质量及镇痛效果的影响。方法:选取125例腰硬联合麻醉行下肢骨折手术老年患者为研究对象,根据选用麻醉药物不同分为A组(n=41)、B组(n=42)和C组(n=42)。A组采用罗哌卡因麻醉(0.5 mg/kg),B组采用罗哌卡因(0.5 mg/kg)+右美托咪定(0.25μg/kg)麻醉,C组采用罗哌卡因(0.5 mg/kg)+右美托咪定(0.5μg/kg)麻醉;比较三组患者术中心率(HR)、收缩压(SBP)和舒张压(DBP)及麻醉恢复质量(QoR-40)评分、术后视觉模拟疼痛(VAS)评分及围术期不良反应。结果:B组和C组患者术中10 min、30 min、60 min及术毕HR、SBP和DBP均小于A组(P<0.05);B组和C组QoR-40量表总分均高于A组(P<0.05);B组和C组术后2 h、6 h、12 h、24 h VAS疼痛评分均低于A组,且C组低于B组(P<0.05);三组患者心动过缓、一过性低血压、一过性高血压、呼吸抑制、胃肠道反应的发生率比较,差异无统计学意义(P>0.05)。结论:老年下肢骨折手术患者在腰硬联合麻醉给予罗哌卡因联合右美托咪定有助于维持术中血流动力学稳定,提高麻醉恢复质量,加强镇痛效果,且安全性好,值得临床推广。

Objective:To explore the influences of combined spinal-epidural anesthesia with dexmedetomidine and ropivacaine on perioperative hemodynamics,anesthesia recovery quality and analgesic effect in elderly patients undergoing lower limb fracture surgery.Methods:A total of 125 elderly patients undergoing lower limb fracture surgery were enrolled and divided into group A(n=41),group B(n=42)and group C(n=42)according to the choice of narcotic drugs.Group A was given 0.5 mg/kg ropivacaine,group B was given 0.5 mg/kg ropivacaine and 0.25μg/kg dexmedetomidine,and group C was given 0.5 mg/kg ropivacaine and 0.5μg/kg dexmedetomidine.The intraoperative heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),the quality of recovery-40(QoR-40),score of postoperative visual analogue scale(VAS)and perioperative adverse reactions were compared among the three groups.Results:The HR,SBP and DBP at 10 min,30 min and 60 min after the start of surgery in group B and group C were lower than those in group A(P<0.05).The total score of QoR-40 in group B and group C was higher than that in group A(P<0.05).VAS scores at 2,6,12 and 24 h after surgery in groups B and C were lower than those in group A,and the group C was lower than the group B(P<0.05).There was no significant difference in the incidence of bradycardia,transient hypotension,transient hypertension,respiratory depression and gastrointestinal reactions among the three groups(P>0.05).Conclusion:Ropivacaine combined with dexmedetomidine in elderly patients with lower limb fracture surgery under combined spinal epidural anesthesia can help maintain hemodynamic stability,improve the quality of anesthesia recovery,strengthen the analgesic effect,and has good safety,which is worthy of clinical promotion.