右美托咪定辅助股神经及坐骨神经阻滞对老年下肢骨折患者免疫功能及麻醉效果的影响

Effects of dexmedetomidine assisted femoral and sciatic nerve block on immune function and anesthetic efficacy in elderly patients with lower limb fractures

目的探讨右美托咪定辅助股神经及坐骨神经阻滞对老年下肢骨折患者免疫功能及麻醉效果的影响。方法选取2020年8月至2022年12月抚州市中医医院实施下肢手术治疗的50例老年下肢骨折患者作为研究对象,随机分为观察组与对照组,每组25例。两组均于超声引导下对前路骨神经、后路坐骨神经实施联合阻滞麻醉,观察组在麻醉成功后予以右美托咪定微量泵入,对照组予以等剂量0.9%氯化钠注射液静脉注射。比较两组给药前(T0)、给药后15 min(T1)、手术开始后15 min(T2)、手术开始后30 min(T3)、手术完毕(T4)血流动力学状态及Ramsay评分;比较两组手术前后免疫功能指标及不良反应发生情况。结果T1时,观察组HR慢于对照组,Ramsay评分高于对照组,差异有统计学意义(P<0.05);T2~T4时,观察组HR均慢于对照组,Ramsay评分高于对照组,观察组T3时MAP低于对照组,差异有统计学意义(P<0.05)。术后,两组CD3+、CD4+水平及CD4+/CD8+均低于术前,但观察组高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为4.00%,低于对照组的32.00%,差异有统计学意义(P<0.05)。结论老年下肢骨折患者实施右美托咪定辅助股神经、坐骨神经阻滞麻醉可使麻醉过程中血流动力学维持在稳定状态,强化镇痛效果,且不会对免疫功能造成明显影响,不良反应发生风险较小,具有较高有效性、安全性,值得临床推广应用。

Objective To explore the effect of dexmedetomidine assisted femoral and sciatic nerve block on immune function and anesthetic effi-cacy in elderly patients with lower limb fracture.Methods 50 cases of elderly patients with lower limb fracture who underwent lower limb surgical treatment in Fuzhou Hospital of Traditional Chinese Medicine from August 2020 to December 2022 were selected as the study subjects,and they were randomly divided into the observation group and the control group,with 25 cases in each group.Both groups were anesthetized under ultra-soundguided combined block of anterior femoral nerve and posterior sciatic nerve,and after successful anesthesia,dexmedetomidine was micro pumped in the observation group,and an equal dose of 0.9%sodium chloride injection was injected intravenously in the control group.The hemody-namic status and Ramsay score of the two groups were compared before(T0),15 min after(T1),15 min after(T2),30 min after(T3),and at the end of(T4)the operation;and the immune function indexes and the occurrence of adverse reactions before and after surgical treatment were compared be-tween the two groups.Results At T1,the HR in the observation group was slower than that in the control group,and the Ramsay score was higher than that in the control group,the differences were statistically significant(P<0.05);at T2-T4,the HR in the observation group was lower than that in the control group,the Ramsay score was higher than that in the control group,and the MAPin the observation group was lower than that in the control group at T3,the differences were statistically significant(P<0.05).After operation,the levels of CD3+,CD4+and CD4+/CD8+of the two groups were lower than those before operation,but the observation group were higher than the control group,the differences were statistically significant(P<0.05).The in-cidence of adverse reactions in the observation group was 4.00%,which was lower than 32.00%in the control group,the difference was statistically sig-nificant(P<0.05).Conclusion Dexmedetomidine-assisted femoral nerve and sciatic nerve block anesthesia in elderly patients with lower limb frac-ture can maintain hemodynamics in the stable state during anesthesia,strengthen the analgesic effect,and will not significantly affect the immune func-tion,and the risk of adverse reactions is relatively small,which is highly effective and safe,and is worthy of clinical promotion and application.