氢吗啡酮复合右美托咪定对老年髋部骨折患者围术期血流动力学的影响

Effect of Hydromorphone Combined with Dexmedetomidine on Perioperative Hemodynamics in Elderly Patients with Hip Fracture

目的:观察氢吗啡酮复合右美托咪定(DEX)对老年髋部骨折患者围术期血流动力学的影响。方法:选取2018年3月-2021年3月本院收治的老年髋部骨折患者98例,按照随机数字表法分为观察组与对照组,各49例。对照组采用氢吗啡酮,观察组采用氢吗啡酮复合DEX。比较麻醉前(T_(0))麻醉15 min(T_(1))、手术完成时(T_(2))和术后3 h(T_(3))两组视觉模拟评分(VAS)、Ramsay镇静评分(RSS)、心率(HR)、血氧饱和度(SpO_(2))、平均动脉压(MAP)、皮质醇(Cor)、去甲肾上腺素(NE)、白细胞介素-6(IL-6);记录两组术后不良反应发生情况。结果:T_(1)、T_(2)、T_(3),观察组VAS评分和RSS均低于同时间点对照组,差异均有统计学意义(P<0.05)。与T_(0)相比,观察组T_(1)、T_(2)、T_(3)的HR、MAP均降低(P<0.05);T_(1)、T_(2)、T_(3),观察组HR、MAP均明显低于对照组(P<0.05)。T_(0)、T_(1)、T_(2)、T_(3),两组SpO_(2)比较,差异均无统计学意义(P>0.05);与T_(0)相比,观察组T_(1)、T_(2)、T_(3)的Cor、NE和IL-6水平均明显升高(P<0.05);T_(1)、T_(2)、T_(3),观察组Cor、NE和IL-6水平均明显低于对照组(P<0.05);观察组不良反应发生率为8.16%,对照组为16.33%,差异无统计学意义(P>0.05)。结论:氢吗啡酮复合DEX可有效维持老年髋部骨折患者围术期血流动力学稳定,增强镇痛镇静效果,降低应激程度,不增加不良反应发生率。

Objective:To observe the effect of Hydromorphone combined with Dexmedetomidine(DEX)on perioperative hemodynamics in elderly patients with hip fracture.Method:A total of 98 elderly patients with hip fracture admitted to our hospital between March 2018 to March 2021 were selected,and they were randomly divided into observation group and control group,with 49 cases in each group.Patients in the control group were treated with Hydromorphone,while patients in the observation group were treated with Hydromorphone and DEX.The visual analogue scale(VAS)scores,Ramsay sedation score(RSS),heart rate(HR),blood oxygen saturation(SpO_(2)),mean arterial pressure(MAP),cortisol(Cor),norepinephrine(NE),interleukin-6(IL-6)were compared between the two groups before anesthesia(T_(0)),15 min after anesthesia(T_(1)),at the completion of operation(T_(2))and 3 h after operation(T_(3));the occurrence of postoperative adverse reactions in the two groups was recorded.Result:T_(1),T_(2) and T_(3),the VAS scores and RSS of the observation group were lower than those of the control group at the same time point,the differences were statistically significant(P<0.05).Compared with T_(0),HR and MAP of T_(1),T_(2) and T_(3) in the observation group decreased(P<0.05);T_(1),T_(2) and T_(3),HR and MAP in the observation group were significantly lower than those in the control group(P<0.05).T_(0),T_(1),T_(2),T_(3),there were no significant differences in SpO_(2) between the two groups(P>0.05);compared with T_(0),the levels of Cor,NE and IL-6 of T_(1),T_(2) and T_(3) were significantly higher in the observation group(P<0.05);T_(1),T_(2),T_(3),the levels of Cor,NE and IL-6 in the observation group were significantly lower than those in the control group(P<0.05);the incidences of adverse reactions in the observation group and the control group were 8.16%and 16.33%,there was no significant difference(P>0.05).Conclusion:Hydromorphone combined with DEX can effectively maintain perioperative hemodynamic stability in elderly patients with hip fracture.Meanwhile,it can enhance the analgesic and sedative effects,and reduce stress,without increasing adverse reactions.