右美托咪定椎管内麻醉对老年下肢骨折手术患者认知功能与应激反应的影响研究

Study on the effect of dexmedetomidine intralesional anesthesia on cognitive function and stress response in elderly patients undergoing lower extremity fracture surgery

目的研究右美托咪定椎管内麻醉对老年下肢骨折手术患者应激反应和认知功能的影响。方法88例老年下肢骨折手术患者,根据随机对照法分为对照组和观察组,每组44例。对照组静脉滴注丙泊酚椎管内麻醉,观察组泵注右美托咪定椎管内麻醉。比较两组不同时间点简易精神状态检查量表(MMSE)评分,应激反应指标[皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)]水平。结果两组术前1d的MMSE评分比较差异无统计学意义(P>0.05);观察组术后2、24h的MMSE评分分别为(20.4±1.5)、(27.3±2.1)分,均显著高于对照组的(17.5±0.6)、(21.4±1.7)分,差异有统计学意义(P<0.05)。两组术前、用药后30min的Cor、E、NE水平比较差异均无统计学意义(P>0.05)。两组用药后30min、用药后1h、术毕的Cor、E、NE水平均显著高于术前,用药后1h、术毕的Cor、E、NE水平均显著高于用药后30min,术毕的Cor、E、NE水平均显著高于用药后1h,差异有统计学意义(P<0.05)。观察组用药后1h、术毕的Cor、E、NE水平均显著低于对照组,差异有统计学意义(P<0.05)。结论右美托咪定椎管内麻醉可显著降低老年下肢骨折手术患者手术应激反应,患者的认知功能恢复更佳,安全性高,值得临床推广。

Objective To study the effect of dexmedetomidine intralesional anesthesia on cognitive function and stress response in elderly patients undergoing lower extremity fracture surgery.Methods A total of 88 cases of elderly patients with lower limb fracture were randomly divided into control group and observation group,with 44 cases in each group.The control group was anesthetized with intravenous infusion of propofol,and the observation group was anesthetized with intravenous infusion of dexmedetomidine.The Mini Mental State Examination(MMSE)score,stress response indexes[cortisol(Cor),epinephrine(E),norepinephrine(NE)]levels at different time points were compared between the two groups.Results There was no statistically significant difference in MMSE scores between the two groups at 1d postoperatively(P>0.05).The MMSE scores at 2 and 24 h postoperatively in the observation group were(20.4±1.5)and(27.3±2.1)points,which were significantly higher than(17.5±0.6)and(21.4±1.7)points in the control group,and the differences were statistically significant(P<0.05).The differences in Cor,E and NE levels preoperatively and 30 min after drug administration in both groups were not statistically significant(P>0.05).The levels of Cor,E and NE in both groups were significantly higher than those 30 min after drug administration,1 h after drug administration and at the end of surgery;the levels of Cor,E and NE 1 h after drug administration and at the end of surgery were significantly lower than those 30 min after drug administration;the levels of Cor,E and NE at the end of surgery were significantly higher than those 1 h after drug administration;the differences were statistically significant(P<0.05).The levels of Cor,E and NE in the observation group 1 h after drug administration and at the end of surgery were significantly higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Intraspinal anesthesia with dexmedetomidine can significantly reduce the surgical stress response of elderly patients with lower limb fracture surgery,and the cognitive function of patients will recover better with high safety,which is worthy of clinical promotion.