右美托咪定复合氯胺酮对老年髋部骨折患者麻醉前摆放侧卧位时疼痛的影响

Effect of dexmedetomidine combined with ketamine in elderly patients with hip fracture at the time of changing position before combined spinal-epidural anesthesia

目的观察右美托咪定复合氯胺酮在髋部骨折手术麻醉前体位变动的镇痛效果。方法选取ASAⅡ或Ⅲ级限期在腰硬联合麻醉下行髋部手术患者60例,随机分为3组:右美托咪定复合氯胺酮组(DK组)、右美托咪定复合芬太尼组(DF组)及对照组(C组),每组20例。分别记录各组入室10 min(T_(0))、体位变动前即刻(T_(1))、体位变动即刻(T_(2))、摆好麻醉体位即刻(T_(3))、维持麻醉体位1 min(T_(4))的MAP、HR、SpO_(2)、VAS评分及Ramsay镇静评分和不良反应。记录腰硬联合一次穿刺成功率及穿刺时间,评估患者配合度及满意度。记录围术期不良反应的发生情况。结果DK组的疼痛视觉模拟评分(VAS)、MAP和HR于T_(1)~T_(4)均显著低于DF组及C组(P<0.05),DK组Ramsay镇静评分高于DF组及C组(P<0.05),腰硬联合一次穿刺成功率DK组大于DF组及C组。DK组术中体动、托下颌、心动过缓发生率明显低于DF组和C组(P<0.05)。结论右美托咪定复合氯胺酮可明显减轻老年患者髋部骨折手术麻醉体位摆放过程中的疼痛,维持稳定的血流动力学,且不良反应轻微。

Objective To investigate the influence of dexmedetomidine combined with ketamine in elderly patients with hip fracture at the time of changing position before combine-epidural anesthesia.Methods Sixty patients undergoing hip surgery under combined spinal and epidural anesthesia at ASAⅡorⅢstage were selected and divided into 3 groups according to random number table method:dexmedetomidine combined with ketamine group(DK group),dexmedetomidine combined with fentanyl group(DF group)and the control group(C group),with 20 patients in each group.The mean arterial pressure(MAP),heart rate(HR),SpO_(2),visual analgesia score(VAS)and Ramsay sedation score were recorded at the point of 10 min after entering the operation room(T_(0)),the immediate time before changing of position(T_(1)),the immediate time at changing of position(T_(2)),the time of finishing anesthesia position(T_(3))and maintaining anesthesia position 1 minute(T_(4))and side effects were recorded.The success rate of combined spine-epidural analgesia and the puncture time were recorded,and patient cooperation and satisfaction were evaluated.The incidence of adverse reactions in perioperative period was recorded.Results VAS score,MAP and HR in the DK group were significantly lower than those in the DF group and the C group from T_(1) to T_(4)(P<0.05),Ramsay sedation score in the DK group was higher than that in the DF group and the C group(P<0.05),and the one-time success rate of combined spinal and epidural anesthesia in the DK group was higher than that in the DF group and the C group.the incidences of body movement,mandibular support and bradycardia in the DK group were significantly lower than those in the DF group and the C group(P<0.05).Conclusion Dexmedetomidine combined with ketamine can significantly relieve pain and maintain stable hemodynamics during anesthesia position placement of hip fracture in elderly patients with minor adverse reactions.