右美托咪定静脉泵注联合七氟醚吸入麻醉在老年膝骨关节炎手术患者中的应用效果

Application effects of Dexmedetomidine intravenous injection combined with Sevoflurane inhalation anesthesia in elderly patients with knee osteoarthritis surgery

目的:观察右美托咪定静脉泵注联合七氟醚吸入麻醉在老年膝骨关节炎手术患者中的应用效果。方法:选取2021年6月至2022年12月该院收治的88例行关节镜清理术治疗的老年膝骨关节炎患者进行前瞻性研究,按照随机数字表法将其分为研究组与对照组各44例。对照组采用七氟醚吸入麻醉,研究组在对照组基础上联合右美托咪定静脉泵注麻醉,比较两组不同时间心率和平均动脉压、疼痛视觉模拟评分法(VAS)评分、应激指标(肾上腺素、去甲肾上腺素、皮质醇)水平和简易精神状态检测量表(MMSE)评分。结果:手术30 min、术毕、术后5 min,研究组心率和平均动脉压低于对照组,差异均有统计学意义(P<0.05);术后6、24、48 h,研究组VAS评分均低于对照组,差异有统计学意义(P<0.05);术后12 h,两组血清皮质醇、肾上腺素、去甲肾上腺素水平高于术前,但研究组低于对照组,差异均有统计学意义(P<0.05);术后1 d,两组MMSE评分均低于术前,但研究组高于对照组,差异有统计学意义(P<0.05)。结论:右美托咪定静脉泵注联合七氟醚吸入麻醉应用于老年膝骨关节炎手术患者可提高术后MMSE评分,降低心率、平均动脉压、应激指标水平和疼痛VAS评分,效果优于单纯七氟醚吸入麻醉。

Objective:To observe application effects of Dexmedetomidine intravenous injection combined with Sevoflurane inhalation anesthesia in elderly patients with knee osteoarthritis surgery.Methods:A prospective study was conducted on 88 elderly patients with knee osteoarthritis who underwent arthroscopic debridement in this hospital from June 2021 to December 2022.They were divided into study group and control group according to the random number table method,44 cases in each group.The control group was treated with Sevoflurane inhalation anesthesia,while the study group was combined with Dexmedetomidine intravenous injection anesthesia on the basis of that of the control group.The heart rate and the mean arterial pressure levels,the pain visual analogue scale(VAS)scores,the stress index(epinephrine,norepinephrine,cortisol)levels,and the mini-mental state examination(MMSE)scores were compared between the two groups at different time points.Results:The heart rate and mean arterial pressure levels of the study group were lower than those of the control group 30 min after the surgery,at the end of the surgery and 5 min after surgery,and the differences were statistically significant(P<0.05).6,24 and 48 h after the surgery,the VAS scores of the study group were lower than those of the control group,and the differences were statistically significant(P<0.05).12 h after the surgery,the levels of serum cortisol,epinephrine and norepinephrine in the two groups were higher than those before operation,but those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Further,1 day after the surgery,the MMSE scores of the two groups were lower than those before the surgery,but that in the study group was higher than that in the control group,and the differences were statistically significant(P<0.05).Conclusions:Dexmedetomidine intravenous injection combined with Sevoflurane inhalation anesthesia in the elderly patients with knee osteoarthritis surgery can improve the postoperative MMSE scores,and reduce the heart rate and mean arterial pressure levels,the stress index levels and the pain VAS scores.Moreover,it is superior to single Sevoflurane inhalation anesthesia.