超声引导下星状神经节阻滞联合右美托咪定对老年髋关节置换术患者应激反应及凝血指标的影响

Effects of ultrasound-guided stellate ganglion block combined with dexmedetomidine on stress response and coagulation indexes in elderly patients undergoing hip replacement

目的 探讨超声引导下星状神经节阻滞联合右美托咪定在老年髋关节置换术中的应用效果。方法 选取2019年4月至2021年4月我院收治的100例老年髋关节置换术患者作为研究对象,以抽签法随机将其分为对照组(50例,在麻醉诱导前静脉泵注右美托咪定)和观察组(50例,在麻醉诱导前行超声引导下星状神经节阻滞联合右美托咪定静脉泵注)。比较两组不同时间的应激反应指标、凝血指标及脑氧代谢指标。结果 切皮后30 min(T1)及术毕时(T2),观察组的皮质醇(Cor)、丙二醛(MDA)水平均低于对照组(P<0.05)。T1、T2时,观察组的D-二聚体(D-D)、纤维蛋白原(FIB)水平均低于对照组(P<0.05)。T1、T2时,观察组的颈内静脉氧饱和度(SjvO2)、脑氧摄取率(CERO2)高于对照组(P<0.05)。结论 临床对老年髋关节置换术患者采用超声引导下星状神经节阻滞联合右美托咪定有助于减轻机体应激反应,缓解血液高凝状态,也能改善脑氧代谢,值得推广。

Objective To investigate the application effect of ultrasound-guided stellate ganglion block combined with dexmedetomidine in elderly patients undergoing hip replacement.Methods From April 2019 to April 2021,100 elderly patients undergoing hip replacement admitted in our hospital were selected as the research objects.The patients were randomly divided into control group(50 cases,intravenous infusion of dexmedetomidine before anesthesia induction)and observation group(50 cases,ultrasound-guided stellate ganglion block combined with intravenous infusion of dexmedetomidine before anesthesia induction)by drawing lots.The stress response indexes,coagulation indexes and cerebral oxygen metabolism indexes at different time were compared between the two groups.Results At 30 min after skin incision(T1)and at the end of operation(T2),the levels of cortisol(Cor)and malondialdehyde(MDA)in the observation group were lower than those in the control group(P<0.05).At T1 and T2,the levels of D-dimer(D-D)and fibrinogen(FIB)in the observation group were lower than those in the control group(P<0.05).At T1 and T2,the internal jugular vein oxygen saturation(SjvO2)and the cerebral extraction of oxygen rate(CERO2)in the observation group were higher than those in the control group(P<0.05).Conclusion Ultrasound-guided stellate ganglion block combined with dexmedetomidine applied in elderly patients with hip replacement can help reduce the stress response of the body in clinical practice,alleviate the hypercoagulable state of blood,and also improve cerebral oxygen metabolism,which is worthy of promotion.