老年患者腰硬联合麻醉下全髋关节置换术中右美托咪定鞘内注射的临床应用效果及对术后疼痛评分的影响研究

Clinical Effectiveness of Intrathecal Dexmedetomidine Injection in Total Hip Arthroplasty under Combined Lumbar and Rigid Anesthesia in Elderly Patients and Its Effect on Postoperative Pain Scores

目的 探讨老年患者腰硬联合麻醉下全髋关节置换术中右美托咪定鞘内注射的临床应用效果及对术后疼痛评分的影响。方法 随机选取2019年7月—2021年7月期间福建省老年医院收治的90例行腰硬联合麻醉下全髋关节置换术的老年患者作为研究对象,采用随机数表法分为对照组和观察组,各45例。对照组在麻醉时使用生理盐水和布比卡因鞘内注射,观察组在麻醉时使用布比卡因和右美托咪定鞘内注射。对两组患者麻醉效果、术后疼痛和围术期不良反应发生情况进行观察比较。结果 观察组感觉阻滞起效时间(6.03±1.23)min、运动阻滞起效时间(7.14±2.12)min均明显短于对照组,差异有统计学意义(t=5.075、3.463,P<0.001)。观察组感觉阻滞持续时间和运动阻滞持续时间均明显长于对照组,差异有统计学意义(P<0.05)。观察组患者1、3、6 h VAS评分均明显低于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率对比,差异无统计学意义(P>0.05)。结论 老年患者腰硬联合麻醉下全髋关节置换术中使用右美托咪定进行鞘内注射有利于维持患者术中生命体征平稳,起效快且作用时间长,不但可以减少患者术后疼痛,而且不会增加患者不良反应发生风险,值得推广应用。

Objective To investigate the clinical effect of intrathecal dexmedetomidine injection in total hip arthroplasty under combined lumbar and rigid anesthesia in elderly patients and its effect on postoperative pain scores.Methods 90 elderly patients undergoing total hip arthroplasty under combined spinal-epidural anesthesia admitted to Fujian Provincial Elderly Hospital from July 2019 to July 2021 were randomly selected as the study subjects.They were divided into a control group and an observation group using a number table method,with 45 patients in each group.The control group used saline and bupivacaine intrathecal injection during anesthesia.In the observation group,bupivacaine and dexmedetomidine were used intrathecally during anesthesia.The anesthetic effect,postoperative pain and perioperative adverse reactions were observed and compared between the two groups.Results The onset of sensory block(6.03±1.23)min and motor block(7.14±2.12)min in the observation group were significantly shorter than those in the control group,and the difference was statistically significant(t=5.075,3.463,P<0.001).The duration of sensory block and duration of motor block in the observation group were significantly longer than those in the control group,and the difference was statistically significant(P<0.05).The 1 h,3 h,6 h VAS scores of patients in the observation group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the incidence of adverse reactions in the two groups(P>0.05).Conclusion Intrathecal injection of dexmedetomidine during total hip arthroplasty under combined lumbar and rigid anesthesia in elderly patients is conducive to maintaining stable intraoperative vital signs of patients,with rapid onset and long duration of action.It can not only reduce postoperative pain but also does not increase the risk of adverse reactions in patients,which is worth promoting.