右美托咪定对老年髋部骨折患者的镇静效果及血流动力学的影响

The Effect of Dexmedetomidine on Sedation and Hemodynamics in Elderly Patients with hip Fractures

目的探讨右美托咪定用于老年髋部骨折患者的镇静效果及对血流动力学的影响。方法选取2022年3月至2023年3月我院收治的90例老年髋部骨折患者为研究对象,按随机数表法分为对照组与观察组,各45例。观察组接受右美托咪定麻醉,对照组予以0.9%氯化钠溶液。比较两组麻醉诱导前(T_(0))、气管插管时(T_(1))、手术进行时(T_(2))、术毕(T_(3))的血流动力学指标,术中体液出入量和拔管时间,术后镇静镇痛效果,术后认知功能,谵妄发生率。结果两组患者平均动脉压及心率的不同时间点对比、组间对比、变化趋势对比差异存在统计学意义(P<0.05),且观察组T_(0)~T_(3)的平均动脉压、心率变化幅度较对照组更小;两组术后6h、24h的Ramsay评分均低于术后10min,两组间Ramsay评分对比,术后10min、6h、24h观察组Price-Henry评分均低于对照组;两组患者拔管时间、术中尿量、术中胶体入量、术中晶体入量对比差异无统计学意义(P>0.05);观察组术后24 h、48 h的MMSE评分较对照组高;观察组术后谵妄发生率较对照组低。结论在老年髋部骨折手术中应用右美托咪定,可保障麻醉平稳快速,维持稳定的血流动力学,且镇静镇痛效果好,缓解术后疼痛,预防谵妄发生。

Objective To explore the sedative effect and hemodynamic impact of dexmedetomidine in elderly patients with hip fractures.Method A total of 90 elderly patients with hip fractures admitted to our hospital from March 2022 to March 2023 were selected as the research subjects.Based on a random number table method,they were divided into two groups,with 45 cases in the control group and 45 cases in the observation group;The observation group received dexmedetomidine anesthesia,while the control group received 0.9%sodium chloride solution;The hemodynamic indexes before anesthesia induction(T_(0)),at the time of Tracheal intubation(T_(1)),at the time of operation(T_(2)),and at the end of operation(T_(3)),the volume of body fluid in and out of the operation,the time of extubation,the effect of postoperative sedation and analgesia,the postoperative cognitive function,and the incidence of delirium were compared between the two groups.Results There were statistical differences between the two groups in the comparison of Mean arterial pressure and heart rate at different time points,between groups,and change trend(P<0.05),and the Mean arterial pressure and heart rate in the observation group at T_(0)-T_(3) were smaller than those in the control group;The Ramsay scores at 6 and 24 hours after surgery in both groups were lower than those at 10 minutes after surgery.The Ramsay scores be tween the two groups were compared,and the Price Henry scores in the observation group were lower than those in the control group at 10 minutes,6 hours and 24 hours after surgery;There was no significant difference in extubation time,intraoperative urine volume,intraoperative colloid intake,and intraoperative crystal intake between the two groups of patients(P>0.05);The MMSE scores of the observation group at 24 and 48 hours after surgery were significantly higher than those of the control group;The incidence of postoperative delirium in the observation group was significantly lower than that in the control group.Conclusion The application of dexmedetomidine in elderly hip fracture surgery can ensure stable and rapid anesthesia,maintain stable hemodynamics,and have good sedative and analgesic effects,alleviate postoperative pain,and prevent delirium.