右美托咪定自控静脉镇痛对老年股骨粗隆间骨折患者的应用效果

Effect of Patient-Controlled Intravenous Analgesia with Dexmedetomidine on Elderly Patients with Femoral Intertrochanteric Fractures

目的探讨右美托咪定自控静脉镇痛(PCIA)对老年股骨粗隆间骨折患者的应用效果。方法选取2019年1月至2021年2月于新里程安钢总医院拟行股骨近端防旋髓内钉内固定术的64例老年股骨粗隆间骨折患者。按随机数字表法将患者分为对照组(32例)和观察组(32例)。术中给予两组患者腰硬联合麻醉。术后给予对照组患者布托啡诺PCIA。术后给予观察组患者右美托咪定联合布托啡诺PCIA。比较两组术后1、2、6、12、24 h心率(HR)、平均动脉压(MAP)、视觉模拟评分(VAS)、Ramsay镇静评分。记录两组术后24 h内不良反应发生情况。结果术后1、2、6、12、24 h,两组MAP、HR水平比较,差异无统计学意义(P>0.05)。术后1、2、6 h,观察组VAS评分低于对照组,Ramsay评分高于对照组(P<0.05)。观察组不良反应发生率低于对照组(P<0.05)。结论右美托咪定PCIA有助于降低老年股骨粗隆间骨折患者术后疼痛程度,镇痛、镇静效果好,不良反应少。

Objective To investigate the effect of patient-controlled intravenous analgesia(PCIA)with dexmedetomidine on elderly patients with femoral intertrochanteric fractures.Methods Sixty-four elderly patients with femoral intertrochanteric fractures who were planned to undergo internal fixation of the proximal femur with anti-rotation intramedullary nails in Xinlicheng Angang General Hospital from January 2019 to February 2021 were selected.According to the random number table method,the patients were divided into control group(32 cases)and observation group(32 cases).During the operation,both groups of patients were given combined spinal-epidural anesthesia.The patients in control group were given PCIA of butorphanol after operation.The patients in observation group were given dexmedetomidine combined with PCIA of butorphanol after operation.Heart rate(HR),mean arterial pressure(MAP),visual analog scale(VAS)and Ramsay sedation score were compared between the two groups at 1,2,6,12 and 24 hours after surgery.The occurrence of adverse reactions within 24 hours after operation was recorded in the two groups.Results There was no statistical difference in the levels of MAP and HR between the two groups at 1,2,6,12 and 24 hours after surgery(P>0.05).At 1,2 and 6 hours after surgery,the VAS score in observation group was lower than that in control group,and the Ramsay score was higher than that in control group(P<0.05).The incidence of adverse reactions in observation group was lower than that in control group(P<0.05).Conclusion PCIA of dexmedetomidine could help reduce postoperative pain in elderly patients with femoral intertrochanteric fractures,with good analgesia and sedation effects and fewer adverse reactions.