右美托咪定复合椎管内麻醉防治老年髋部骨折患者术后谵妄的有效性分析

Efficacy analysis of dexmedetomidine combined with intraspinal anesthesia in the prevention and treatment of postoperative delirium in elderly patients with hip fracture

目的分析右美托咪定复合椎管内麻醉防治老年髋部骨折患者术后谵妄的有效性。方法选取2020年1月至2021年1月于本院诊治的66例老年髋部骨折患者作为研究对象,随机分为研究组与对照组,每组33例。对照组实施常规椎管内麻醉,研究组实施右美托咪定复合椎管内麻醉,比较两组血流动力学指标、疼痛程度及谵妄发生率。结果两组心率、平均动脉压组间、时间、交互比较差异有统计学意义(P<0.05)。组内比较:研究组T1时心率小于T0,T2时心率大于T1,平均动脉压低于T0、T1,T3时心率均低于T0、T1、T2,平均动脉压低于T0、T1,高于T2,差异有统计学意义(P<0.05);对照组T1时平均动脉压高于T0,T2时心率大于T0、T1,平均动脉压低于T0、T1,T3时心率大于T0、T1,小于T2,平均动脉压高于T0、T2,低于T1,差有统计学意义(P<0.05)。组间比较:T1、T2、T3,研究组心率均小于对照组,平均动脉压均低于对照组,差异有统计学意义(P<0.05)。两组视觉模拟评分法(VAS)评分组间、时间、交互比较差异有统计学意义(P<0.05)。组内比较:研究组术后各时间点VAS评分高于前一时间点,差异有统计学意义(P<0.05);对照组术后6 h VAS评分高于术后1 h,术后12 h VAS评分高于术后1 h,低于术后6 h,差异有统计学意义(P<0.05)。组间比较:术后1、6、12 h,研究组VAS评分均低于对照组,差异有统计学意义(P<0.05)。研究组术后谵妄发生率为3.03%,低于对照组的24.24%,差异有统计学意义(P<0.05)。结论右美托咪定复合椎管内麻醉防治老年髋部骨折患者术后谵妄效果显著,安全性高,对患者血流动力学影响较小,可减轻术后疼痛程度,降低谵妄发生率,临床应用价值较高。

Objective To analyze the efficacy of dexmedetomidine combined with intraspinal anesthesia in the prevention and treatment of postoperative delirium in elderly patients with hip fracture.Methods 66 elderly patients with hip fracture treated in our hospital from January 2020 to January 2021 were selected as the research subjects,and they were randomly divided into the study group and the control group,with 33 cases in each group.The control group was given intraspinal anesthesia,and the study group was given dexmedetomidine combined with intraspinal anesthesia.The hemodynamic indexes,pain degree and incidence of delirium were compared between the two groups.Results There were significant differences of heart rate,mean arterial pressure between two groups of group,time points and interaction(P<0.05).Comparison within the group:in the study group,the heart rate at T1 was lower than that at T0,the heart rate at T2 was higher than that at T1,the mean artery pressure was lower than that at T0 and T1,the heart rate at T3 was lower than that at T0,T1 and T2,the mean artery pressure was lower than that at T0 and T1,but higher than that at T2,the differences were statistically significant(P<0.05);in the control group,the mean arterial pressure at T1 was higher than that at T0,the heart rate at T2 was higher than that at T0 and T1,the mean arterial pressure was lower than that at T0 and T1,the heart rate at T3 was higher than that at T0 and T1,but lower than that at T2,the mean arterial pressure was higher than that at T0 and T2,but lower than that at T1,the differences were statistically significant(P<0.05).Comparison between groups:at T0,there were no significant differences in heart rate and mean arterial pressure between the two groups;at T1,T2,T3,the heart rate of the study group was lower than that in the control group,and the mean arterial pressure was lower than that in the control group,the differences were statistically significant(P<0.05).There was significant difference of visual analog scale(VAS)scores between two groups of group,time points and interaction(P<0.05).Comparison within the group:the VAS score at each time point after operation was higher than that at the previous time point,and the difference was statistically significant(P<0.05);the VAS score of the control group at 6 h after surgery was higher than that at 1 h after surgery,and the VAS score at 12 h after surgery was higher than that at 1 h after surgery but lower than that at 6 h after surgery,and the difference was statistically significant(P<0.05).Comparison between groups:1,6,12 h after surgery,the VAS score in the study group was lower than that in the control group,and the differences were statistically significant(P<0.05).The incidence of postoperative delirium in the study group was 3.03%,which was lower than 24.24%in the control group,and the difference was statistically significant(P<0.05).Conclusion Dexmedetomidine combined with intraspinal anesthesia is effective in preventing and treating postoperative delirium in elderly patients with hip fracture,with high safety and little influence on hemodynamics,which can alleviate postoperative pain and incidence of delirium,and has high clinical application value.