右美托咪定辅助腰丛坐骨神经阻滞对老年股骨干骨折患者麻醉镇痛药使用量及疼痛程度的影响

Effect of Dexmedetomidine-assisted Lumbar Plexus sciatic Nerve Block on the Use of narcotic Analgesics and the Degree of Pain in elderly Patients with femoral Shaft Fracture

目的研究右美托咪定+腰丛坐骨神经阻滞运用于老年股骨干骨折中的价值。方法选择2021年1月至2022年6月河南科技大学第一附属医院收治的80例老年股骨干骨折患者,以随机列表法分为研究组和对照组,分别40例,研究组采取右美托咪定+腰丛坐骨神经阻滞+全身麻醉,对照组给予全身麻醉。比较两组舒张压、收缩压、心率、镇痛药及麻醉药的剂量、视觉模拟(VAS)评分、满意度、白介素-2(IL-2)、肿瘤坏死因子-α(TNF-α)、不良反应,比较各组的麻醉结果。结果术中1 h(T_(1))、术中2 h(T_(2))、术中3 h(T_(3))时,研究组舒张压、心率高出对照组,但收缩压低于对照组,差异有统计学意义(P<0.05)。研究组苏醒时、术后12 h、术后24 h,镇痛药的剂量少于对照组,差异有统计学意义(P<0.05)。研究组苏醒时、术后6 h、术后12 h、术后24 h,VAS评分均较对照组降低,差异有统计学意义(P<0.05)。诱导阶段(T0)时,各组的麻醉药剂量差异无统计学意义(P>0.05),T_(1)、T_(2)、T_(3)时研究组少于对照组,且研究组术中剂量、麻醉阶段剂量较对照组更低,差异有统计学意义(P<0.05)。研究组满意度(92.50%)高于对照组(75.00%),差异有统计学意义(P<0.05)。手术前,各组IL-2、TNF-α差异无统计学意义(P>0.05),术后12 h、术后24 h时研究组指标均低于对照组,差异有统计学意义(P<0.05)。研究组不良反应发生率(15.00%)与对照组(10.00%)比较,差异无统计学意义(P>0.05)。结论右美托咪定+腰丛坐骨神经阻滞的效果更为理想,可稳定患者生命体征,减少麻醉剂量的同时快速减轻疼痛,并减轻炎性反应,不良反应少,患者满意度高。

Objective To study the value of dexmedetomidine-assisted lumbar plexus sciatic nerve block in the treatment of femoral shaft fracture in the elderly.Methods A total of 80 elderly patients with femoral shaft fracture admitted to the First Affiliated Hospital of Henan University of Science and Technology from January 2021 to June 2022 were divided into the study group and the control group according to the random list method,with 40 cases respectively.The study group was treated with dexmedetomidine + lumbar plexus sciatic nerve block + general anesthesia, and the control group was given general anesthesia. The diastolic blood pressure, systolic blood pressure, heart rate, dose of analgesics and anesthetics, visual analogue (VAS) score, satisfaction, interleukin-2 (IL-2), tumor necrosis factor-α (TNF-α), adverse reactions between the two groups were compared, the anesthesia results of each group was compared. Results At 1 h (T_(1)), 2 h (T_(2)) and 3 h (T_(3)), the diastolic blood pressure and heart rate in the study group were higher than those in the control group, but the systolic blood pressure was lower than that in the control group, the difference was statistically significant (P < 0.05). The dose of analgesics in the study group was lower than that in the control group at the time of awakening, 12 hours after operation and 24 hours after operation, the difference was statistically significant (P < 0.05). The VAS score of the study group was significantly lower than that of the control group at the time of awakening, 6 hours, 12 hours and 24 hours after operation, the difference was statistically significant (P < 0.05). At the induction stage (T0), there was no statistically significant difference in the anesthetic dose of each group (P > 0.05). At T_(1), T_(2) and T_(3), the study group was less than the control group, and the intraoperative dose and anesthetic dose of the study group were lower than those of the control group, the difference was statistically significant (P < 0.05). The satisfaction of the study group (92.50%) was higher than that of the control group (75.00%), with a statistically significant difference (P < 0.05). Before operation, there was no significant difference in IL-2 and TNF-α levels among the groups (P > 0.05). The indexes in the study group were lower than those in the control group at 12 hours and 24 hours after operation, and the difference was statistically significant (P < 0.05). The incidence of adverse reactions in the study group (15.00%) was not significantly different from that in the control group (10.00%) (P > 0.05). Conclusion The effect of dexmedetomidine plus lumbar plexus sciatic nerve block is more ideal. It can stabilize the patient's vital signs, reduce the amount of anesthetic, quickly relieve pain, and reduce inflammatory reactions, with fewer adverse reactions and high patient satisfaction.