右美托咪定联合区域神经阻滞镇痛对老年骨科手术患者术后镇痛镇静效果及生活质量的影响

Effect of Dexmedetomidine Combined with Regional Nerve Block Analgesia on Postoperative Analgesia,Sedation and Quality of Life in Elderly Patients Undergoing Orthopedic Surgery

目的探讨右美托咪定联合区域神经阻滞镇痛对老年骨科手术患者术后的镇痛、镇静效果及生活质量的影响。方法选取医院2020年1月至2021年1月就诊的股骨颈骨折或股骨头坏死住院患者134例,随机分为观察组和对照组,各67例。所有患者均行髋关节置换术,对照组患者围术期给予区域神经阻滞镇痛,观察组在对照组基础上静脉泵注右美托咪定1.0μg/(kg·h)至手术结束。结果观察组患者术前干预后30 min(T_(1))、术前(T_(2))、手术麻醉后10 min(T_(3))、手术麻醉后30 min(T_(4))、术后(T_(5))、术后镇痛后30 min(T_(6))的视觉模拟评分量表(VAS)评分均显著低于对照组(P<0.05);观察组患者上述时间点的Ramsay镇静量表评分均显著高于对照组(P<0.05);观察组患者的血氧分压、血氧饱和度均显著高于对照组,血二氧化碳分压显著低于对照组(P<0.05);术后,观察组患者的生命质量量表各项指标评分均显著高于对照组(P<0.05);观察组和对照组不良反应发生率相当(14.93%比8.96%,P>0.05)。结论右美托咪定联合区域神经阻滞镇痛对老年骨科手术患者术后镇痛、镇静的效果显著,可改善患者血气指标,提高生活质量,且安全性良好。

Objective To investigate the effect of dexmedetomidine combined with regional nerve block analgesia on postoperative analgesia,sedation and quality of life in elderly patients undergoing orthopedic surgery.Methods A total of 134 inpatients with femoral neck fracture or femoral head necrosis admitted to the hospital from January 2020 to January 2021 were selected and randomly divided into the observation group and the control group,with 67 cases in each group.All patients underwent hip replacement surgery.Patients in the control group were given regional nerve block analgesia during the perioperative period,on this basis,Patients in the observation group were given 1.0μg/(kg·h)of dexmedetomidine by intravenous pump until the end of the surgery.Results The Visual Analogue Scale(VAS)scores at 30 min after preoperative intervention(T_(1)),before surgery(T_(2)),10 min after surgical anesthesia(T_(3)),30 min after surgical anesthesia(T_(4)),after surgery(T_(5))and 30 min after postoperative analgesia(T_(6))in the observation group were significantly lower than those in the control group(P<0.05),while Ramsay Sedation Scale(RSS)scores at the above time points in the observation group were significantly higher than those in the control group(P<0.05).The partial pressure of oxygen(PaO_(2))and oxygen saturation(SaO_(2))in the observation group were significantly higher than those in the control group,while the partial pressure of carbon dioxide(PaCO_(2))in the observation group was significantly lower than that in the control group(P<0.05).After the surgery,the quality of life scores of each index in the observation group were significantly higher than those in the control group(P<0.05).The incidence of adverse reactions in the observation group was similar to that in the control group(14.39%vs.8.96%,P>0.05).Conclusion Dexmedetomidine combined with regional nerve block analgesia in elderly patients undergoing orthopedic surgery is effective and safe in postoperative analgesia and sedation,which can improve the blood gas index and the quality of life of patients.