右美托咪定复合瑞芬太尼静脉泵注辅助局部麻醉下对腰椎滑脱术患者血流动力学及认知障碍的影响

Effect of intravenous pumping of dexmedetomidine combined with remifentanil-assisted local anesthesia on hemodynamics and cognitive dysfunction in patients undergoing lumbar spondylolisthesis

目的 探讨右美托咪定复合瑞芬太尼静脉泵注辅助局部麻醉下对腰椎滑脱术患者血流动力学及认知障碍的影响。方法 将2021年1月至2022年10月遵义市播州区人民医院麻醉科治疗的74例腰椎滑脱手术患者按随机数表法分为两组,对照组使用全身麻醉,观察组使用右美托咪定复合瑞芬太尼静脉泵注辅助局部麻醉,比较两组的术中血流动力学指标、镇痛及镇静相关指标、不良反应、认知功能。结果 观察组切皮时、术中30 min、术毕时的平均动脉压(MAP)、心率(HR)均高于对照组,差异有统计学意义(P <0.05)。观察组切皮时、术中30 min、术毕时的警觉/镇静观察评分(OAA/S)低于对照组,差异有统计学意义(P <0.05)。观察组恶心呕吐、眩晕、心悸、躁动不良反应总发生率低于对照组,差异有统计学意义(P <0.05)。观察组术后12、24、48、72 h的简易智力状态检查量表(MMSE)评分明显高于对照组,术后认知功能障碍(POCD)发生率明显低于对照组,差异有统计学意义(P <0.05)。结论 右美托咪定复合瑞芬太尼静脉泵注辅助局部麻醉下能有效稳定腰椎滑脱术患者的血流动力学,提高术中镇痛镇静效果,且不良反应发生率低,术后认知功能恢复快,发生POCD的概率低。

Objective To explore the effect of intravenous pumping of dexmedetomidine combined with remifentanil-assisted local anesthesia on hemodynamics and cognitive dysfunction in patients undergoing lumbar spondylolisthesis.Methods A total of 74 patients who underwent lumbar spondylolisthesis surgery at the Anesthesiology Department of People's Hospital of Zunyi City Bozhou District from January 2021 to October 2022 were divided into two groups by a random number table method.The control group received general anesthesia,while the observation group received an intravenous pumping of dexmedetomidine combined with remifentanilassisted local anesthesia.The intraoperative hemodynamic indicators,analgesic and sedative-related indicators,adverse reactions,and cognitive function of the two groups were compared.Results The mean arterial pressure(MAP) and heart rate(HR) of the observation group at the time of skin incision,30 minutes during surgery,and at the end of surgery were higher than those of the control group,with statistically significant differences(P < 0.05).The observer's assessment of alertness/sedation scale(OAA/S) scores of the observation group at the time of skin incision,30 minutes during surgery,and at the end of surgery were lower than those of the control group,with statistically significant differences(P < 0.05).The total incidence of adverse reactions such as nausea,vomiting,dizziness,palpitations,and restlessness in the observation group was lower than that in the control group,with statistically significant difference(P < 0.05).The score of mini-mental state examination(MMSE) of the observation group at 12,24,48,and 72 h after surgery was significantly higher than that of the control group,and the incidence of postoperative cognitive dysfunction(POCD) was significantly lower than that of the control group,with statistically significant differences(P < 0.05).Conclusion Intravenous pumping of dexmedetomidine combined with remifentanil-assisted local anesthesia can effectively stabilize the hemodynamics of patients undergoing lumbar spondylolisthesis,improve intraoperative analgesic and sedative effects,and have a low incidence of adverse reactions,rapid postoperative cognitive function recovery,and a low probability of POCD.