右美托咪定联合罗哌卡因辅助臂丛神经阻滞麻醉在老年骨折患者中的临床疗效分析

Clinical Efficacy of Dexmedetomidine Combined with Ropivacaine Assisted Brachial Plexus Block Anesthesia in Elderly Fractures

目的:观察右美托咪定联合罗哌卡因在老年骨科手术患者臂丛神经阻滞麻醉中的应用效果及对其生命体征指标的影响。方法:本文为前瞻性研究,病例纳入2020年3月-2022年5月于禹州市人民医院接受手术的126例老年骨折患者作为研究对象,经抽签法,按1∶1比例将其分为联合组和对照组,每组各63例,两组术中均经臂丛神经注射罗哌卡因进行阻滞麻醉,联合组在此基础上采用右美托咪定辅助麻醉,比较两组患者的术中、术后镇痛效果,术后体征指标及不良事件发生情况。结果:两组患者麻醉前(T0)的平均动脉压(MAP)、心率(HR)比较,差异无统计学意义(P>0.05);联合组麻醉10 min (T1)、30 min (T2)、术毕时(T3)的MAP分别为(76.32±0.31) mmHg、(75.35±0.22) mmHg、(74.12±0.33) mmHg,均低于对照组(76.65±0.88) mmHg、(75.62±0.81) mmHg、(74.45±0.83) mmHg,差异有统计学意义(t=2.807、2.553、2.933;P<0.05);HR分别为(65.34±0.11)次/min、(64.21±0.25)次/min、(63.11±0.13)次/min,均低于对照组的(65.66±0.85)次/min、(64.57±0.82)次/min、(63.46±0.81)次/min,差异有统计学意义(t=2.963、3.333、3.203,P<0.05);术后30 min、1 h、3 h、5 h的视觉模拟疼痛(VAS)评分分别为(4.42±0.31)分、(3.77±0.25)分、(3.14±0.25)分、(2.26±0.37)分,均低于对照组的(4.71±0.83)分、(4.04±0.82)分、(3.52±0.85)分、(2.61±0.81)分,差异有统计学意义(t=2.598、2.500、3.404、3.120,P<0.05),自控镇痛泵(PCA)按压次数为(10.11±0.24)次/24 h,低于对照组的(10.48±0.88)次/24 h,差异有统计学意义(t=3.220,P<0.05)、停用时间为(40.25±0.31) h,低于对照组的(40.61±0.83) h,差异有统计学意义(t=3.225,P<0.05);苏醒后的收缩压(SBP)为(125.11±10.32) mmHg,低于对照组的(130.45±10.28) mmHg,差异有统计学意义(t=2.910,P<0.05);舒张压(DBP)为(85.44±1.36) mmHg,低于对照组的(86.26±1.45) mmHg,差异有统计学意义(t=3.274,P<0.05);心率(HR)为(105.44±5.25)次/min,低于对照组的(108.42±5.31)次/min,差异有统计学意义(t=3.168,P<0.05);麻醉药物副反应及术后并发症发生率为7.94%,略高于对照组的6.35%,差异无统计学意义(χ^(2)=0.191,P>0.05)。结论:在老年骨折手术患者术中联合应用右美托咪定辅助罗哌卡因臂丛神经阻滞麻醉可显著增强术中、术后镇痛效果,对维持患者苏醒后体征稳定有积极作用,且此麻醉方法未明显增强副反应以及术后并发症等不良事件发生风险,安全性较高。

Objective:To observe the effect of dexmedetomidine combined with ropivacaine on brachial plexus block anesthesia in elderly patients undergoing orthopaedic surgery and its influence on vital signs.Methods:126 elderly fracture patients who were operated on in the hospital from March 2020 to May 2022 were taken as the research object.They were divided into a combined group and a control group according to the ratio of 1∶1 by drawing lots.There were 63 patients in each group.During the operation,ropivacaine was injected into the brachial plexus for block anesthesia.On this basis,dexmedetomidine was used as an auxiliary anesthesia to compare the analgesic effects of the two groups during and after the operation,postoperative signs and adverse events.Results:There was no significant difference in MAP and HR between the two groups before anesthesia(T0)(P>0.05).MAP at 10 min(T1),30 min(T2)and at the end of operation(T3)in the combined group were(76.32±0.31)mmHg,(75.35±0.22)mmHg,(74.12±0.33)mmHg,respectively,which were lower than those in the control group(76.65±0.88)mmHg,(75.62±0.81)mmHg,(74.45±0.83)mmHg,with statistically significant differences(t=2.807,2.553,2.933;P<0.05).HR was(65.34±0.11)times/min,(64.21±0.25)times/min,(63.11±0.13)times/min,respectively,which were lower than that of the control group(65.66±0.85)times/min,(64.57±0.82)times/min,(63.46±0.81)times/min,with statistically significant difference(t=2.963,3.333,3.203;P<0.05).The VAS scores of 30 min,1 h,3 h and 5 h after operation were(4.42±0.31)(3.77±0.25)(3.14±0.25)and(2.26±0.37),respectively,which were lower than those of the control group(4.71±0.83)(4.04±0.82)(3.52±0.85)and(2.61±0.81)(t=2.598,2.500,3.404,3.120;P<0.05).The number of PCA compression was(10.11±0.24)times/24 h,which was lower than(10.48±0.88)times/24 h of the control group,with statistically significant difference(t=3.220,P<0.05).The stopping time(40.25±0.31)h was lower than that of the control group(40.61±0.83)h,and the difference was statistically significant(t=3.225,P<0.05).SBP was(125.11±10.32)mmHg after awakening,which was significantly lower than(130.45±10.28)mmHg of the control group(t=2.910,P<0.05).DBP was(85.44±1.36)mmHg,which was lower than(86.26±1.45)mmHg of control group,with statistically significant difference(t=3.274,P<0.05).HR was(105.44±5.25)times/min was lower than that(108.42±5.31)times/min in the control group(t=3.168,P<0.05).The incidence of side effects of anesthetic drugs and postoperative complications was 7.94%,which was slightly higher than 6.35%in the control group(χ^(2)=0.191,P>0.05).Conclusion:The combined application of dexmedetomidine assisted ropivacaine brachial plexus block anesthesia during the operation of elderly fracture patients can significantly enhance the analgesic effect during and after the operation,and has a positive role in maintaining the stability of the patient’s physical signs after awakening.Moreover,this anesthesia method does not significantly enhance the risk of adverse events such as side effects and postoperative complications,and it is safe.