超声引导下椎管内麻醉在老年患者髋关节置换术有效性及安全性探讨

Analysis of the effectiveness and safety of ultrasound-guided spinal anesthesia in elderly patients undergoing hip replacement

目的探讨右美托咪定辅助椎管内麻醉在老年患者髋关节置换术中的有效性及安全性。方法选取2020-07-01-2021-07-01南阳张仲景医院收治的老年髋关节置换术患者98例作为研究对象,按照随机数字表法分为对照组(n=49)和联合组(n=49)。对照组给予椎管内麻醉,联合组给予椎管内麻醉+右美托咪定辅助麻醉。对比2组手术指标、血流动力学指标〔心率(HR)、平均脉动圧(MAP)〕、脑氧代谢情况〔颈内静脉球部血氧饱和度(SjvO2)、脑氧含量(CjvO2)、脑氧摄取率(CERO2)〕、应激反应指标〔总抗氧化能力(T-AOC)、脂质过氧化氢(LHP)、超氧化物歧化酶(SOD)〕及不良反应发生率。结果联合组术后麻醉留观时间为(12.71±1.97)min,短于对照组的(28.52±3.41)min,差异有统计学意义t=28.102,P<0.05。联合组麻醉后(T1)MAP为(85.91±6.85)mmHg、术中30min(T2)为(82.71±5.41)mmHg、术后即刻(T3)为(81.24±6.93)mmHg,对照组T1为(90.24±7.88)mmHg、T2为(87.52±4.52)mmHg、T3为(85.43±6.94)mmHg,差异有统计学意义,t值分别为2.903、4.776和2.991,均P<0.05。联合组术中30min和术后即刻SjvO2分別为(64.74±9.81)、(69.62±10.34)mL/L,均高于对照组的(59.58±10.25)、(62.37±9.51)mL/L,差异有统计学意义,t值分别为2.546和3.613,均P<0.05;联合组术中30min和术后即刻CjvO2分別为(92.68±11.41)、(88.51±10.32)mL/L,均高于对照组的(87.60±12.37)、(83.78±9.95)mL/L,差异有统计学意义,t值分别为2.113和2.310,均P<0.05;联合组术中30min和术后即刻CERO2分別为(34.71±4.98)%、(31.92±4.85)%,差异有统计学意义,均低于对照组的(39.41±6.87)%、(35.26±5.96)%,差异有统计学意义,t值分别为3.877和3.043,均P<0.05。联合组术中30min和术后即刻T-AOC分別为(5.71±0.891)、(3.42±0.68)U/mL,均低于对照组的(6.52±0.74)、(4.89±0.85)U/mL,差异有统计学意义,t值分别为7.899和9.453,均P<0.05;联合组术中30min和术后即刻LHP分別为(7.94±0.88)、(10.35±1.42)μmol/L,均高于对照组的(6.15±0.62)、(7.86±0.96)μmol/L,差异有统计学意义,t值分别为11.640和10.169,均P<0.05;联合组术中30min和术后即刻SOD分別为(56.71±6.74)、(35.73±5.85)U/mL,均低于对照组的(71.78±7.44)、(48.66±6.97)U/mL,差异有统计学意义,t值分别为10.508和9.947,均P<0.05。联合组不良反应发生率为10.20%,低于对照组的26.53%,差异有统计学意义,χ^(2)=4.356,P<0.05。结论右美托咪定辅助椎管内麻醉可提升老年患者髋关节置换术中麻醉效果,并改善血流动力学指标、脑氧代谢情况、应激反应,降低不良反应发生率。

Objective To investigate the efficacy and safety of dexmedetomidine assisted spinal anesthesia in elderly patients undergoing hip replacement.Methods A total of 98elderly patients with hip arthroplasty admitted to Nanyang Zhang Zhongjing Hospital from July 1,2020to July 1,2021were selected as the study subjects.They were divided into a control group(n=49)and a combined group(n=49)according to a random number table method.The control group was given intraspinal anesthesia,while the combined group was given intraspinal anesthesia plus dexmedetomidine assisted anesthesia.The surgical parameters,hemodynamic parameters[heart rate(HR),mean pulsatile pressure(MAP)],cerebral oxygen metabolism[Internal jugular vein bulb blood oxygen saturation(SjvO2),brain oxygen content(CjvO2),brain oxygen uptake rate(CERO2)],stress response indicators[Total antioxidant capacity(T-AOC),lipid peroxide(LHP),superoxide dismutase(SOD)],and the incidence of adverse reactions were compared between the two groups.Results The postoperative anesthesia observation time in the combined group was(12.71±1.97)min,which was shorter than that in the control group(28.52±3.41)min.The difference was statistically significant(t=28.102,P<0.05).In the combined group,T1MAP was(85.91±6.85)mmHg,T2was(82.71±5.41)mmHg,and T3was(81.24±6.93)mmHg,while in the control group,T1was(90.24±7.88)mmHg,T2 was(87.52±4.52)mmHg,and T3 was(85.43±6.94)mmHg,and the difference was statistically significant(t=2.903,4.776,2.991,all P<0.05).The SjvO2levels in the combined group were(64.74±9.81)mL/L and(69.62±10.34)mL/L at 30minutes during operation and immediately after operation,which were significantly higher than those in the control group(59.58±10.25)mL/L and(62.37±9.51)mL/L,t=2.546and 3.613,respectively,with a statistically significant difference(P<0.05);The CjvO2levels in the combined group were(92.68±11.41)mL/L and(88.51±10.32)mL/L at 30minutes during the operation and immediately after the operation,compared with(87.60±12.37)mL/L and(83.78±9.95)mL/L,respectively,in the control group,with a statistically significant difference(t=2.113and 2.310,both P<0.05);In the combined group,the intraoperative and immediate postoperative CERO2levels were(34.71±4.98)%and(31.92±4.85)%,respectively,lower than those in the control group(39.41±6.87)%and(35.26±5.96)%,with a statistically significant difference(t=3.877and 3.043,P<0.05).The T-AOCs in the combined group were(5.71±0.891)U/mL and(3.42±0.68)U/mL at 30minutes during operation and immediately after operation,which were lower than those in the control group(6.52±0.74)U/mL and(4.89±0.85)U/mL,with a statistically significant difference(t=7.899and 9.453,both P<0.05);In the combined group,the LHP was(7.94±0.88)μmol/L at 30min during operation and(10.35±1.42)μmol/L immediately after operation,which were higher than those in the control group(6.15±0.62)μmol/L and(7.86±0.96)μmol/L,the difference was statistically significant,(t=11.640,10.169,both P<0.05);The SOD levels in the combined group were(56.71±6.74)U/mL and(35.73±5.85)U/mL at 30minutes during and immediately after surgery,both were lower than those in the control group(71.78±7.44)U/mL and(48.66±6.97)U/mL,with a statistically significant difference(t=10.508and 9.947,both P<0.05).The incidence of adverse reactions in the combination group was 10.20%,lower than that in the control group 26.53%,with a statistically significant difference,χ^(2)=4.356,P<0.05.Conclusion Dextrmetomidine assisted spinal anesthesia can improve the anesthetic effect during hip replacement surgery in elderly patients,improve hemodynamic parameters,cerebral oxygen metabolism,stress reactions,and reduce the incidence of adverse reactions.