右美托咪定对腰硬联合麻醉下行足踝手术的老年患者镇静效果、生命体征的影响

Effects of dexmedetomidine on sedation and vital signs of elderly patients undergoing foot and ankle surgery under combined lumbar and epidural anesthesia

目的探讨对腰硬联合麻醉下行足踝手术的老年患者予右美托咪定的镇静效果及对其生命体征的影响。方法选择南通市海门区三厂街道中心卫生院2015年1月至2019年12月收治的腰硬联合麻醉下行足踝手术的老年患者60例,以随机数表法将患者分组,对照组(n=30)予咪达唑仑镇静,观察组(n=30)予右美托咪定镇静。于镇静前、镇静后10 min采用脑电双频指数、焦虑视觉模拟/焦虑状态问卷(anxiety visual analogue/anxiety questionnaire,AVA/SAI)及警觉/镇静评分(observer's assessment of alertness/sedation,OAA/S)评估患者的镇静状态,并监测镇静前后生命体征;采集患者术前、术后1 d空腹静脉血检测CD3+、CD4+、CD4+/CD8+水平,以评估免疫状态,并统计两组的不良反应发生情况。结果观察组镇静后10 min的AVA/SAI评分、OAA/S评分分别为(0.61±0.16)分、(3.26±0.48)分,均低于对照组,差异有统计学意义(P<0.05)。观察组镇静10 min后心率、平均动脉压、呼吸频率分别为(75.33±6.85)次/min、(82.12±7.15)mmHg、(15.25±1.31)次/min,均低于对照组,差异有统计学意义(P<0.05)。观察组术后1 d的CD3+、CD4+、CD4+/CD8+水平分别为(55.92±4.05)%、(29.46±2.76)%、(0.94±0.25),均高于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(20.00%vs 10.00%,P>0.05)。结论对行足踝手术的老年患者在腰硬联合麻醉基础上予右美托咪定干预,可提高镇静效果,有利于维持患者的体征稳定,对T淋巴细胞亚群的影响小,镇静方案安全性高。

Objective To effects of dexmedetomidine on sedation and vital signs of elderly patients undergoing foot and ankle surgery under combined lumbar and epidural anesthesia.Methods From January 2015 to December 2019,60 elderly patients were grouped by a random number table method,the control group(n=30)was sedated with midazolam,the observation group(n=30)was sedated dexmedetomidine.The EEG double-frequency index and anxiety visual simulation/anxiety status questionnaire were used at 10 min after sedation(anxiety visual analogue/anxiety questionnaire,AVA/SAI)and alert/sedation score(observer’s assessment of alertness/sedation,OAA/S)to assess the sedation status of the patients;and vital signs were monitored before and after sedation;immunological status was assessed by measuring CD3+,CD4+and CD4+/CD8+levels before and 1 d after surgery;the occurrence of adverse reactions in the two groups were also counted.Results The AVA/SAI and OAA/S scores of 10 min after sedation were(0.61±0.16)points and(3.26±0.48)points,which were smaller than those of the control group and the diffrence was significant(P<0.05).Heart rate,mean arterial pressure and respiratory rate after 10 min of sedation were(75.33±6.85)times/min,(82.12±7.15)mmHg and(15.25±1.31)times/min,respectively,which were lower than that of the control group,with a statistically significant difference(P<0.05).The CD3+,CD4+and CD4+/CD8+levels were(55.92±4.05)%,(29.46±2.76)%and(0.94±0.25)at 1 d after surgery,respectively,which were all higher than the control group and were statistically significant(P<0.05).The incidence of adverse effects between the two groups was not significant(20.00%vs 10.00%,P>0.05).Conclusion For the elderly patients who underwent foot and ankle surgery dexmedetomidine intervention on the basis of combined anesthesia can improve the sedative effect,help to maintain the stability of patients'physical signs,have little impact on T lymphocyte subsets,and the sedative regimen.