右美托咪定辅助腰硬阻滞麻醉对老年骨折患者术后应激反应及认知功能的影响

Effects of dexmedetomidine-assisted spinal epidural anesthesia on postoperative stress response and cognitive function in elderly patients with fractures

目的:探究右美托咪定辅助腰硬阻滞麻醉对老年骨折患者术后应激反应及认知功能的影响。方法:2019年6月-2020年6月收治接受骨折手术治疗的老年患者168例,随机分为两组,各84例。对照组给予腰硬阻滞麻醉;试验组在腰硬阻滞麻醉基础上加用右美托咪定。比较两组患者麻醉前(T_(0))、手术结束时(T_(1))、手术结束后6 h(T_(2))血清去甲肾上腺素(NE)、肾上腺素(E)水平以及术前1天、术后第7天简易精神状态量表(MMSE)评分。结果:两组T_(0)时NE及E水平比较,差异无统计学意义(P>0.05);试验组T_(1)、T_(2)时NE及E水平均低于对照组,差异有统计学意义(P<0.05)。两组术前1天MMSE评分比较,差异无统计学意义(P>0.05);试验组术后第7天MMSE评分高于对照组,差异有统计学意义(P<0.05)。结论:采用腰硬阻滞麻醉辅以右美托咪定对老年骨折患者进行麻醉,能够减轻对患者认知功能的影响,并减轻应激反应。

Objective:To explore the effect of dexmedetomidine-assisted spinal anesthesia on postoperative stress response and cognitive function in elderly patients with fractures.Methods:From June 2019 to June 2020,168 elderly patients who underwent fracture surgery were selected,they were randomly divided into the two groups with 84 cases in each group.The control group was given spinal epidural anesthesia.The experimental group was given dexmedetomidine on the basis of spinal epidural anesthesia.The serum norepinephrine(NE)and epinephrine(E)levels before anesthesia(T_(0)),at the end of the operation(T_(1)),and 6 hours after the end of the operation(T_(2))were compared between the two groups of patients.The Mini-Mental State Examination(MMSE)score were compared between the two groups 1 day before operation and 7 days after operation.Results:There was no statistically significant difference in the levels of NE and E between the two groups at T_(0)(P>0.05).The levels of NE and E at T_(1) and T_(2) in the experimental group were lower than those in the control group,the difference was statistically significant(P<0.05).There was no statistically significant difference in MMSE scores between the two groups on the first day before surgery(P>0.05).The MMSE score of the experimental group was higher than that of the control group on the 7th day after surgery,the difference was statistically significant(P<0.05).Conclusion:The use of spinal epidural anesthesia supplemented with dexmedetomidine to anesthetize elderly patients with fractures can reduce the impact on the cognitive function of the patients and reduce the stress response.