右美托咪定和咪达唑仑在腰麻-硬膜外联合阻滞下用于老年髋关节置换术患者镇静中的效果对比

Comparison of Sedation Effect of Dexmedetomidine and Midazolam under Combined Spinal-epidural Anesthesia on Elderly Patients Undergoing Hip Replacement

目的:对比右美托咪定和咪达唑仑在腰麻-硬膜外联合阻滞下用于老年髋关节置换术患者中的镇静效果。方法:回顾性分析上饶市人民医院2022年7月—2023年9月收治的100例老年髋关节置换术患者的临床资料,根据麻醉方式的不同将其分为咪达唑仑组31例、小剂量右美托咪定组34例、中等剂量右美托咪定组35例,三组均采用腰麻-硬膜外联合阻滞。咪达唑仑组以2 mg/min的速度静脉注射咪达唑仑0.05 mg/kg,小剂量右美托咪定组和中等剂量右美托咪定组于10 min内静脉泵注负荷剂量的右美托咪定0.6μg/kg,然后分别以0.3μg/(kg·h)和0.6μg/(kg·h)右美托咪定术中持续泵注。比较三组麻醉前、切皮时、切皮后10 min、术毕前10 min时患者呼吸频率(RR)、血氧饱和度(SpO_(2))、心率(HR),对比三组术后麻醉恢复效果(术后苏醒时间、术后是否谵妄),统计三组麻醉不良反应发生率。结果:麻醉前,三组间RR、SpO_(2)、HR比较,差异均无统计学意义(P>0.05)。切皮时、切皮后10 min、术毕前10 min,三组RR、SpO_(2)、HR与麻醉前比较均降低,差异均有统计学意义(P<0.05);切皮时、切皮后10 min、术毕前10 min三组SpO_(2)、HR比较,差异均无统计学意义(P>0.05)。切皮时,咪达唑仑组、中等剂量右美托咪定组RR均低于小剂量右美托咪定组(P<0.05);切皮后10 min、术毕前10 min,小剂量右美托咪定组RR均高于中等剂量右美托咪定组,差异均有统计学意义(P<0.05)。咪达唑仑组术后苏醒时间长于小剂量右美托咪定组、中等剂量右美托咪定组,术后7 d内谵妄发生率高于小剂量右美托咪定组、中等剂量右美托咪定组,差异均有统计学意义(P<0.05)。咪达唑仑组麻醉不良反应总发生率高于中等剂量右美托咪定组,差异有统计学意义(P<0.05)。结论:在腰麻-硬膜外联合阻滞下老年髋关节置换术的镇静中,中等剂量右美托咪定与咪达唑仑均具有较好的镇静效果,其中0.6μg/(kg·h)右美托咪定术中镇静效果更好,患者术中躁动发生更低,术后谵妄发生率更低,麻醉不良反应更少。

Objective:To compare the sedation effect of Dexmedetomidine and Midazolam under combined spinal-epidural anesthesia on elderly patients undergoing hip replacement.Method:The clinical data of 100 elderly patients with hip replacement admitted to Shangrao People's Hospital were retrospectively analyzed from July 2022 to September 2023,they were classified into Midazolam group(31 cases),low-dose Dexmedetomidine group(34 cases)and medium-dose Dexmedetomidine group(35 cases)by different anesthesia methods,the three groups were given combined spinal-epidural anesthesia.The Midazolam group was intravenously injected with 0.05 mg/kg at a rate of 2 mg/min,and the low-dose Dexmedetomidine group and medium-dose Dexmedetomidine group were given intravenous pump loading dose of Dexmedetomidine 0.6μg/kg within 10 min and was then continuous pump at 0.3μg/(kg·h)and 0.6μg/(kg·h).The respiratory rate(RR),blood oxygen saturation(SpO_(2))and heart rate(HR)before anesthesia,at skin incision,at 10 min after skin incision and at 10 min before the end of surgery and postoperative anesthetic recovery effect(postoperative recovery time,presence or absence of postoperative delirium)were compared,and the incidence rates of adverse anesthesia reactions were statistically analyzed.Result:Before anesthesia,there were no significant differences in RR,SpO_(2) and HR among the three groups(P>0.05).At skin incision,at 10 min after skin incision and at 10 min before the end of surgery,RR,SpO_(2) and HR in the three groups were reduced compared with those before anesthesia,the differences were statistically significant(P<0.05);at skin incision,at 10 min after skin incision and at 10 min before the end,there were no statistical differences in SpO_(2) and HR among the three groups(P>0.05).At skin incision,the RR in Midazolam group and medium-dose Dexmedetomidine group was lower than that in low-dose Dexmedetomidine group(P<0.05);at 10 min after skin incision and at 10 min before the end of surgery,the RR in low-dose Dexmedetomidine group was higher than that in medium-dose Dexmedetomidine group,the differences were statistically significant(P<0.05).The postoperative recovery time in Midazolam group was longer than that of the low-dose Dexmedetomidine group and medium-dose Dexmedetomidine group,and incidence rate of postoperative delirium within 7 days after operation in Midazolam group was higher than that in low-dose dexmedetomidine group and medium-dose Dexmedetomidine group(P<0.05).The total incidence rate of adverse anesthesia reactions in Midazolam group was higher than that in medium-dose Dexmedetomidine group,the difference was statistically significant(P<0.05).Conclusion:In the sedation of elderly patients undergoing hip replacement under combined spinal-epidural anesthesia,both medium-dose Dexmedetomidine and Midazolam have good sedation effect,among which 0.6μg/(kg·h)Dexmedetomidine has better intraoperative sedation effect,lower incidence rate of intraoperative agitation,lower incidence rate of postoperative delirium and fewer anesthesia adverse reactions.