右美托咪定复合椎管内麻醉对老年髋部骨折术后谵妄防治的价值

Value of Dexmedetomidine Combined with Intravertebral Anesthesia for the Prevention and Treatment of Delirium after Hip Fracture Surgery in the Elderly

目的 探析对老年髋部骨折患者应用右美托咪定复合椎管内麻醉方案对预防术后谵妄并发症的临床价值。方法 随机选取联勤保障部队第九〇〇医院莆田医疗区2019年1月—2021年12月收治的60例老年髋部骨折择期手术治疗干预患者,通过随机数表法分为对照组、观察组,各30例。均为椎管内麻醉,对照组麻醉后泵入生理盐水,观察组泵入右美托咪定。比较两种方式麻醉质量及安全性。结果 观察组患者术后2、4、12 h的VAS分数均低于对照组,差异有统计学意义(P<0.05)。观察组患者术后谵妄发生率(16.67%)低于对照组(46.67%),差异有统计学意义(P<0.05),谵妄持续时间短于对照组[(0.81±0.23)d vs (2.52±0.61)d],差异有统计学意义(P<0.05)。术后观察组不良反应发生率(6.67%)低于对照组(26.67%),差异有统计学意义(χ^(2)=4.320,P<0.05)。结论 为老年髋部骨折患者采取右美托咪定复合椎管内麻醉方式有更优秀的镇痛效果,对预防术后谵妄风险有积极作用,保障手术安全进行。

Objective To investigate the clinical value of applying dexmedetomidine compound intralesional anesthe⁃sia protocol to elderly hip fracture patients to prevent postoperative delirium complications.Methods Sixty patients ad⁃mitted to the Putian Medical District of the 900th Military Hospital of the Joint Security Force between January 2019 and December 2021 for elective surgical treatment intervention of geriatric hip fractures were randomly selected.Pa⁃tients were divided into control and observation groups by the random number table method,30 cases in each group.All were given intravertebral anesthesia,and saline was pumped after anesthesia in the control group and dexmedeto⁃midine was pumped in the observation group.The quality and safety of anesthesia were compared between the two mo⁃dalities.Results The VAS scores of patients in the observation group were lower than those in the control group at 2 h,4 h and 12 h postoperatively,the difference was statistically significant(P<0.05).The incidence of postoperative de⁃lirium in the observation group(16.67%)was lower than that in the control group(46.67%)and the duration of de⁃lirium was shorter than that in the control group[(0.81±0.23)d vs(2.52±0.61)d],the difference was statistically sig⁃nificant(P<0.05).Postoperative adverse reactions in the observation group were 6.67%,which was lower than 26.67%in the control group,the difference was statistically significant(χ^(2)=4.320,P<0.05).Conclusion Adopting dexmedetomidine compound intralesional anesthesia for elderly hip fracture patients has a better analgesic effect,and has a posi⁃tive effect in preventing the risk of postoperative delirium and guaranteeing the safe performance of surgery.