髋部骨折手术患者应用右美托咪定复合椎管内麻醉的效果分析

Effect of Dexmedetomidine Combined with Intraspinal Anesthesia in Patients Undergoing Hip Fracture Surgery

目的探究髋部骨折手术患者应用右美托咪定复合椎管内麻醉的效果。方法选取我院2019年6月~2021年5月收治的94例髋部骨折患者为研究对象,采用随机数字表法将患者分为复合组(n=48)和对照组(n=46)。复合组患者行手术时接受右美托咪定复合椎管内麻醉,对照组以相同剂量生理盐水代替右美托咪定。比较两组患者T0(麻醉前)、T1(麻醉后15min)、T2(手术完成时)和T3(手术后3 h)时疼痛视觉模拟量表评分(visu⁃al analogue score,VAS)、镇静深度根据镇静(Ramsay)评分、平均动脉压(Mean arterial pressure,MAP)和心率(Heart rate,HR),并观察记录两组患者不良反应发生情况。结果复合组患者T1、T2和T3时的VAS评分均低于T0时,Ramsay评分高于T0时,且在这三个时间点,复合组VAS评分均低于对照组,Ramsay评分高于对照组(P<0.05)。两组患者MAP和HR在T0时均无统计学差异(P>0.05)。在T1、T2、T3时,两组患者MAP出现先下降后回升的趋势,HR均呈上升趋势,但复合组波动更小(P<0.05)。复合组不良反应发生率8.33%低于对照组26.09%(P<0.05)。结论采用右美托咪定复合椎管内麻醉方案对髋部骨折患者的麻醉效果较好,其镇痛质量高,镇静程度深,对患者血流动力学影响小,同时能够减少不良反应的发生。

Objective To discuss the effect of dexmedetomidine combined with intraspinal anesthesia in patients under⁃going hip fracture surgery.Methods Ninety⁃four patients with hip fracture in our hospital from June 2019 to May 2021 were enrolled,and classified into two groups according to random number table methods.Combined group(n=48)received dexmedetomidine assisted intraspinal anesthesia.In control group(n=46),dexmedetomidine was replaced with the same dose of saline.The visual analog score(VAS),sedation depth according to sedation(Ramsay)score,mean arterial pressure(MAP)and heart rate(HR)of patients in the two groups at T0(before anesthesia),T1(15min after anesthesia),T2(after surgery)and T3(3h after surgery)were compared,and the adverse reactions of patients in the two groups were observed and recorded.Results The VAS score at T1,T2 and T3 in the composite group was lower than that at T0,and Ramsay score was higher than that at T0.At these three time points,the VAS score in the composite group was lower than that in the con⁃trol group,and Ramsay score was higher than that in the control group(P<0.05).There was no significant difference in MAP and HR between the two groups at T0(P>0.05).At T1,T2 and T3,MAP in the two groups decreased first and then increased,and HR increased,but the fluctuation in the composite group was smaller(P<0.05).The incidence of adverse reactions in the compound group was 8.33%lower than that in the control group(26.09%,P<0.05).Conclusion The combination of dexmedetomidine and intraspinal anesthesia has a good anesthetic effect on patients with hip fracture.It has high quality of analgesia,deep sedation,little impact on patients′hemodynamics,and can reduce the occurrence of adverse reactions.