右美托咪定对胸腰椎骨折内固定术患者的麻醉效果

Anesthetic effect of dexmedetomidine in patients undergoing internal fixation of thoracolumbar fractures

目的分析右美托咪定用于胸腰椎骨折内固定术患者的麻醉效果。方法以收治的166例胸腰椎骨折内固定术患者为研究对象,用随机数字表法分为对照组和观察组,各83例。对照组进行常规麻醉,观察组在对照组常规麻醉的基础上联合右美托咪定进行麻醉,2组术后均观察5 d。统计2组术中情况,比较2组麻醉诱导前30 min(t_(0))、手术结束时(t_(1))和术后2 h(t_(2))的血氧代谢指标、血流动力学指标、血清应激因子水平及术前1 d、术后3 d和术后5 d的认知功能。结果观察组术中尿量高于对照组(P<0.05),瑞芬太尼、丙泊酚用量低于对照组(P<0.05)。2组血清乳酸(serum lactic acid,Lac)水平t_(1)高于t_(0)(P<0.05),对照组t_(2)高于t_(0)、低于t_(1)(P<0.05),观察组t_(1)、t_(2)低于对照组(P<0.05);2组血清谷氨酸(glutamic acid,Glu)水平t_(1)高于t_(0)、t_(2)(P<0.05)。2组心率(heart rate,HR)t_(1)低于t_(0),观察组t_(2)低于t_(0)、t_(1),对照组t_(2)高于t_(0),低于t_(1)(P<0.05),观察组t_(1)、t_(2)低于对照组(P<0.05);2组平均动脉压(mean arterial pressure,MAP)t_(1)高于t_(0),对照组t_(2)高于t_(0),观察组t_(2)低于t_(1)(P<0.05),观察组t_(1)、t_(2)低于对照组(P<0.05)。2组血清皮质醇(cortisol,Cor)水平t_(1)高于t_(0),t_(2)低于t_(1)(P<0.05),观察组t_(1)低于对照组(P<0.05);2组血清血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)水平t_(2)、t_(1)低于t_(0),t_(2)低于t_(1)(P<0.05),观察组t_(2)、t_(1)低于对照组(P<0.05);2组血清S-100β蛋白水平t_(2)、t_(1)高于t_(0),t_(2)低于t_(1)(P<0.05),观察组t_(2)、t_(1)低于对照组(P<0.05)。术后3 d、术后5 d,对照组认知功能评分低于术前1 d,且低于观察组(P<0.05)。结论胸腰椎骨折内固定术患者采用右美托咪定麻醉可有效增加患者的术中尿量,减少麻醉药物的使用,改善患者的血氧代谢、血流动力学指标及认知功能,降低患者术中、术后应激,具有较好的麻醉效果。

Objective To analyze the anesthetic effect of dexmedetomidine in patients undergoing internal fixation of thoracolumbar fractures.Methods A total of 166 patients undergoing thoracolumbar fractures treated with internal fixation were enrolled and divided into control group(83 cases)and observation group(83 cases)by random number table method.The control group received conventional anesthesia,and the observation group received anesthesia combined with dexmedetomidine on the basis of the control group.The 2 groups were observed for 5 days after surgery.The intraoperative conditions of the 2 groups were counted.The blood oxygen metabolism indexes,the levels of hemodynamic index in peripheral blood,and the levels of serum stress factor at 30 minutes before induction of anesthesia(t_(0)),at the end of surgery(t_(1)),and at the 2 hours after surgery(t_(2)),and the cognitive function of preoperative 1,3 and 5 days after surgery were compared between the 2 groups.Results The urine volume in the observation group was higher than that in the control group(P<0.05),and the dosage of remifentanil and propofol were lower than that in the control group(P<0.05).The levels of serum lactic acid(Lac)in the both groups at t_(1) were higher than at t_(0)(P<0.05).Meanwhile,in the control group at t_(2)was higher than at t_(0) and lower than at t_(1)(P<0.05),and t_(1) and t_(2) in the observation group were lower than those in the control group(P<0.05).The levels of serum glutamic acid(Glu)in the both groups at t_(1) were higher than those at t_(0)and t_(2)(P<0.05).The heart rate(HR)of the both groups at t_(1) was lower than at t_(0)and t_(2)in the observation group was lower than t_(0)and t_(1).t_(2) in the control group was higher than t_(0)and lower than t_(1)(P<0.05).t_(1) and t_(2) in the observation group were lower than those in the control group(P<0.05).The mean arterial pressure(MAP)in the both groups at t_(1)in the 2 was higher than at t_(0),while t_(2)in the control group was higher than t_(0).t_(2)in the observation group was lower than t_(1)(P<0.05),and t_(1)and t_(2)in the observation group were lower than those in the control group(P<0.05).The levels of serum cortisol(Cor)at t_(1)was higher than at t_(0),and t_(2)was lower than t_(1)in both groups(P 0.05),and t_(1)in the observation group was lower than that in the control group(P<0.05).The levels of serum angiotensinⅡ(AngⅡat t_(2)and t_(1)in the both groups were lower than at t_(0),t_(2)was lower than t_(1)(P<0.05),and t_(2)and t_(1)in the observation group were lower than in the control group(P<0.05).The levels of serum S-100βat t_(2)and t_(1)in the both groups were higher than at t_(0),and t_(2)was lower than t_(1)(P<0.05),t_(2)and t_(1)in the observation group was lower than that in the control group(P<0.05).After surgery 3 and 5 days,the score of cognitive function in the control group was lower than that of the preoperative 1 day,and lower than that in the observation group(P<0.05).Conclusion Dexmedetomidine anesthesia for thoracolumbar fractures treated with internal fixation patients could effectively increase the intraoperative urine volume,reduce the use of anesthetic drugs,improve patients'blood oxygen metabolism,and the levels of hemodynamic index in peripheral blood and cognitive function,and reduce the intraoperative and postoperative stress,with better anesthesia effect.