右美托咪定联合腰硬阻滞麻醉在股骨粗隆间骨折患者中的应用效果

The application effect of Dexmedetomidine combined with spinal epidural anesthesia in patients with femoral intertrochanteric fractures

目的探讨右美托咪定联合腰硬阻滞麻醉在股骨粗隆间骨折患者中的应用效果。方法选取2019年1月至2020年12月句容市中医院收治的106例股骨粗隆间骨折患者作为研究对象,采用随机数字表法分为对照组(53例)和观察组(53例)。两组均予以腰硬阻滞麻醉,对照组于麻醉成功后15 min内泵入生理盐水持续至术毕前30 min,观察组以同样方式予以右美托咪定。比较两组的血流动力学、应激反应指标、认知功能、不良反应发生情况。结果麻醉前5 min(T0)时,两组的心率(HR)、平均动脉压(MAP)比较,差异无统计学意义(P>0.05);麻醉后10 min(T_(1))、术毕时(T_(2))、术后1 h(T_(3))时,观察组的HR、MAP低于同期对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)、T_(3)时,对照组的HR、MAP高于本组T0时,差异有统计学意义(P<0.05);T_(2)时,观察组的HR、MAP高于本组T0时,差异有统计学意义(P<0.05)。T0时,两组的皮质醇(Cor)、血糖(GLU)比较,差异无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)时,观察组的Cor、GLU低于同期对照组,差异有统计学意义(P<0.05);T_(1)、T_(2)、T_(3)时,对照组Cor、GLU高于本组T0时,差异有统计学意义(P<0.05);T_(2)时,观察组Cor高于本组T0时,差异有统计学意义(P<0.05);T_(1)、T_(2)时,观察组GLU高于本组T0时,差异有统计学意义(P<0.05)。术前,两组简易智能量表(MMSE)评分比较,差异无统计学意义(P>0.05);术后1、3、7 d,两组MMSE评分低于本组术前,差异有统计学意义(P<0.05);术后1、3、7 d,观察组MMSE评分高于同期对照组,差异有统计学意义(P<0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定联合腰硬阻滞麻醉在股骨粗隆间骨折患者中效果明显,能够保障其血流动力学稳定,控制应激反应,认知功能损伤少,且无严重不良反应,安全可行。

Objective To explore the effect of Dexmedetomidine combined with spinal epidural anesthesia in patients with femoral intertrochanteric fractures.Methods A total of 106 patients with intertrochanteric fractures of the femur admitted to Jurong City Hospital of Traditional Chinese Medicine from January 2019 to December 2020 were selected as the research objects.They were divided into the control group(53 cases)and the observation group(53 cases)according to the random number table method.Both groups were given spinal epidural anesthesia.In the control group,normal saline was pumped within 15 minutes after successful anesthesia and continued to 30 minutes before the end of the operation.The observation group was given Dexmedetomidine in the same way.The hemodynamics,stress response indicators,cognitive function,and adverse reactions occur of the two groups were compared.Results At 5 minutes before anesthesia(T0),there were no statistically significant differences of heart rate(HR),meverage arterial pressure(MAP)between the two groups(P>0.05).At 10 minutes after anesthesia(T_(1)),the end of the operation(T_(2)),postoperative 1 hours(T_(3)),the HR and MAP of the observation group were lower than that of the control group at the same period,with statistically significant differences(P<0.05).At T_(1),T_(2),T_(3),the HR and MAP of the control group were higher than that at T0 in the group,with statistically significant differences(P<0.05).At T_(2),the HR and MAP of the observation group were higher than that at T0 in the group,with statistically significant differences(P<0.05).At T0,there were no statistically significant differences of cortisol(Cor),blood glucose(GLU)between the two groups(P>0.05).At T_(1),T_(2),T_(3),the Cor and GLU of the observation group were lower than that of the control group at the same period,with statistically significant differences(P<0.05).At T_(1),T_(2),T_(3),the Cor and GLU of the control group were lower than that of at T0 in the group,with statistically significant differences(P<0.05).At T_(2),the Cor of the observation group was higher than that at T0 in the group,with statistically significant difference(P<0.05).At T_(1),T_(2),the GLU of the observation group was higher than that at T0 in the group,with statistically significant difference(P<0.05).At T0,there was no statistically significant difference of mini-mental state examination(MMSE)score between the two groups(P>0.05).On 1,3,7 days after surgery,the MMSE score of the two groups were lower than those before surgery in the group,with statistically significant differences(P<0.05).On 1,3,7 days after surgery,the MMSE score of the observation group were higher than those of the control group on the same period,with statistically significant differences(P<0.05).There was no statistically significant difference of total incidence of adverse reactions between the two groups(P>0.05).Conclusion Dexmedetomidine combined with spinal epidural anesthesia is effective in patients with intertrochanteric fractures.It can ensure stable hemodynamics,control stress response,less cognitive impairment,and no serious adverse reactions.It is safe feasible.