腰硬联合麻醉复合右美托咪定在下肢骨折患者中的应用效果

Application effect of lumbar epidural anesthesia combined with dexmedetomidine in patients with lower limb fracture

目的探讨腰硬联合麻醉复合右美托咪定在下肢骨折患者中的应用效果.方法回顾性分析2018年7月-2023年12月50例下肢骨折患者的临床资料,按麻醉方法不同分为两组,对照组(n=26)予腰硬联合麻醉,观察组(n=24)予腰硬联合麻醉复合右美托咪定.比较两组血流动力学、Ramsay镇静评分以及术中术后情况.结果两组基线心率(HR)、平均动脉压(MAP)比较无明显差异(P>0.05),椎管内麻醉5min观察组MAP明显高于对照组(P<0.05),使用咪达唑仑后10min、30min及术毕时,观察组MAP和HR均明显高于对照组(P<0.05).两组使用咪达唑仑后10min的Ramsay镇静评分比较,无明显差异(P>0.05),使用咪达唑仑后30min观察组评分明显高于对照组(P<0.05),术毕时两组评分比较,无明显差异(P>0.05).两组术中输液量比较,无明显差异(P>0.05),观察组术中用药率明显低于对照组(P<0.05).两组不良反应比较,无明显差异(P>0.05).结论下肢骨折术中采取腰硬联合麻醉复合右美托咪定,有利于保证麻醉效能,维持术中循环系统稳定,减少术中用药.

Objective To investigate the application effect of lumbar epidural anesthesia combined with dexmedetomidine in patients with lower limb fracture.Methods The clinical data of 50 patients with lower extremity fracture from July 2018 to December 2023 were retrospectively analyzed and divided into two groups according to different anesthesia methods.The control group(n=26)received combined lumbar and epidural anesthesia,and the observation group(n=24)received combined lumbar and epidural anesthesia combined with dexmedetomidine.Hemodynamics,Ramsay sedation score and intraoperative and postoperative conditions were compared between the two groups.Results There were no significant differences in baseline heart rate(HR)and mean arterial pressure(MAP)between the two groups(P>0.05).The MAP in the observation group was significantly higher than that in the control group(P<0.05)for 5min after intraspinal anesthesia,and the MAP and HR in the observation group were significantly higher than that in the control group at 10min and 30min after midazolam and at the end of the operation(P<0.05).There was no significant difference in the score of Ramsay sedation between the two groups at 10min after midazolam administration(P>0.05),and the score in the observation group at 30min after midazolam administration was significantly higher than that in the control group(P<0.05),and there was no significant difference in the score between the two groups at the end of the operation(P>0.05).There was no significant difference in the amount of intraoperative infusion between the two groups(P>0.05),and the rate of intraoperative medication in the observation group was significantly lower than that in the control group(P<0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).Conclusion The combination of spinal and epidural anesthesia with dexmedetomidine during the operation of lower extremity fracture is beneficial to ensure the anesthetic efficiency,maintain the stability of the intraoperative circulatory system and reduce the intraoperative drug use.