右美托咪定复合全麻对老年股骨颈骨折患者术中血流动力学及麻醉诱导后各时间点Ramsay评分的影响

Effect of dexmedetomidine compound general anesthesia on intraoperative hemodynamics and Ramsay score at various time points after induction of anesthesia in elderly patients with femoral neck fractures

目的:探究右美托咪定(Demedetomidine,DEX)复合全麻(General anesthesia,GA)对老年股骨颈骨折(Femoral neck fracture,FNF)患者的影响。方法:选取2020年6月~2022年6月我院收治的96例老年FNF患者作为研究对象,按麻醉方案不同分成研究组和常规组,各48例。两组患者均进行GA髋关节置换术,麻醉诱导前研究组静脉泵注DEX,常规组静脉泵注生理盐水。比较两组苏醒时间、拔管时间、血流动力学水平、Ramsay镇静评分(Ramsay sedationscore,RSS)评分、应激指标水平和不良反应发生率。结果:研究组给药10min(T1)、切皮时(T3)、术毕时(T4)时刻心率(Heart rate,HR)、平均动脉压(Mean arterial pressure,MAP)水平较常规组高,气管插管时(T2)时刻HR、MAP水平较常规组低(P<0.05);两组苏醒时间、拔管时间、不良反应发生率无明显差异(P>0.05);T1、T2、T3、T4时刻研究组RSS评分较常规组高(P<0.05);与常规组相比,术后6 h、24 h研究组血清皮质醇(Cortisol,Cor)、肾上腺素(Adrenaline,AD)、去甲肾上腺素(Noradrenaline,NE)水平更低(P<0.05)。结论:DEX复合GA应用于老年FNF患者可维持机体血流动力学稳定,保持镇静状态,减轻应激反应,且不影响苏醒时间、拔管时间,安全性高。

Objective:To explore the effect of dexmedetomidine(DEX)combined with general anesthesia(GA)on elderly patients with femoral neck fracture(FNF).Methods:Atotal of 96 elderly patients with FNF admitted to our hospital from June 2020 to June 2022 were selected as the study subjects.They were divided into the study group and the conventional group according to different anesthesia schemes,with 48 cases each.Both groups of patients underwent GA hip arthroplasty.Before anesthesia induction,DEX was pumped intravenously in the study group,and normal saline was pumped intravenously in the conventional group.The recovery time,extubation time,hemodynamic level,Ramsay sedation score(RSS)score,stress index level,and the incidence of adversereactions were compared between the two groups.Results:The levels of heart rate(HR)and mean arterial pressure(MAP)at administration 10min(T1),skin incision(T3)and postoperative(T4)in the study group were higher than those in the conventional group,while the levels of HR and MAP at endotracheal intubation(T2)were lower than those in the conventional group(P<0.05).There was no significant difference between the two groups in awakening time,extubation time and incidence of adverse reactions(P>0.05).The RSS score of the study group at T1,T2,T3 and T4 was higher than that of the conventional group(P<0.05).Compared with the conventional group,the serum cortisol(Cor),adrenaline(AD)and norepinephrine(NE)levels in the study group were lower at 6 and 24 hours after operation(P<0.05).Conclusion:The application of DEX combined with GA in elderly patients with FNF can maintain the stability of body hemodynamics,maintain the state of sedation,reduce the stress response,and have no effect on the time of awakening and extubation,with high safety.