右美托咪定联合超声引导下臂丛麻醉在上肢骨折手术中的麻醉效果及对睡眠质量的影响

The Anesthetic Effect of Dexmedetomidine combined with Brachial Plexus Anesthesia Guided by B-ultrasound in Upper Limb Fracture Surgery and Its Effect on Sleep Quality

目的:探讨右美托咪定联合超声引导下臂丛麻醉在上肢骨折手术中的麻醉效果及对睡眠质量的影响。方法:选取2021年1月至2021年12月华侨大学附属德化医院麻醉科收治的上肢骨折患者70例作为研究对象,按照患者的麻醉方案分为观察组与对照组,每组35例。对照组给予臂丛神经麻醉方案,观察组采用右美托咪定联合臂丛麻醉方案。采用Ramsay镇静评分方法在麻醉即刻(T0)、麻醉5 min(T1)、术中30 min(T2)、术毕即刻(T3)对麻醉效果进行评价;在T0、T1、T2、T3记录2组患者的平均动脉压、心率并对比;采用数字评价量表(NRS)在术后2 h、术后4 h、术后8 h、术后12 h时评价患者的术后疼痛情况;采用匹兹堡睡眠质量指数(PSQI)比较2组患者的睡眠质量,同时统计患者麻醉药物不良反应发生情况。结果:麻醉后,观察组在T0、T1、T2、T3时Ramsay镇静显著高于对照组,观察组在T0、T1、T2、T3之间的血压、心率波动小于对照组,观察组术后2 h、术后4 h、术后8 h、术后12 h时NRS评分显著低于对照组,2组比较差异均有统计学意义(均P<0.05);术后,观察组PSQI评分显著低于对照组,2组比较差异有统计学意义(P<0.05);2组药物不良反应发生率比较差异无统计学意义(P>0.05)。结论:右美托咪定联合臂丛麻醉在上肢骨折手术中表现良好,可维持理想的镇静、镇痛效果,同时能够有效控制术中血流动力学的波动,且该麻醉方案安全性能够得到保障,有助于患者获得理想的睡眠质量。

Objective:To investigate the effect of dexmedetomidine combined with B-ultrasound guided brachial plexus anesthesia in upper limb fracture surgery and its effect on sleep quality.Methods:A total of 70 patients with upper limb fracture admitted to the Department of Anesthesiology,Dehua Hospital Affiliated to Huaqiao University from January 2021 to December 2021 were selected as the research objects.According to the anesthesia scheme of the patients,they were divided into observation group and control group,with 35 cases in each group.The control group was given brachial plexus anesthesia,and the observation group was given dexmedetomidine combined brachial plexus anesthesia.Ramsay sedation score was used to evaluate the anesthetic effect immediately after anesthesia(T0),5 minutes after anesthesia(T1),30 minutes during surgery(T2),and immediately after surgery(T3).The mean arterial pressure and heart rate of the two groups were recorded and compared at T0,T1,T2 and T3.Numerical Rating Scale(NRS)was used to evaluate postoperative pain at 2 h,4 h,8 h,and 12 h after surgery.Pittsburgh Sleep Quality Index(PSQI)was used to compare the sleep quality of the two groups,and the incidence of adverse reactions to anesthesia drugs was also analyzed.Results:After anesthesia,Ramsay sedation in the observation group was significantly higher than the control group at T0,T1,T2 and T3.The blood pressure and heart rate fluctuations between T0,T1,T2 and T3 in the observation group were less than those in the control group.At 2 h,4 h,8 h and 12 h after surgery,the NRS score of the observation group was significantly lower than the control group,the differences between the two groups were statistically significant(P s<0.05).After operation,the PSQI score of the observation group was significantly lower than that of the control group,and the difference between the two groups was statistically significant(P<0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups(P>0.05).Conclusion:Dexmedetomidine combined with brachial plexus anesthesia performs well in upper limb fracture surgery.It can maintain ideal sedative and analgesic effects,and can effectively control intraoperative hemodynamic fluctuations,and the safety of this anesthesia program can be guaranteed,helping patients to obtain ideal sleep quality.