右美托咪定联合臂神经丛麻醉对老年肱骨干骨折的麻醉效果

Effect of dexmedetomidine combined with brachial plexus anesthesia in elderly patients with humeral shaft fracture

目的 探讨右美托咪定联合臂神经丛麻醉对老年肱骨干骨折患者的麻醉效果。方法 选取收治的老年肱骨干骨折患者作为研究对象,随机分为对照组和试验组,每组44例。对照组给予臂神经丛麻醉,试验组给予右美托咪定联合臂神经丛麻醉。比较2组患者的麻醉效果(感觉阻滞起效时间、感觉阻滞维持时间、运动阻滞起效时间和运动阻滞维持时间),麻醉后2、4、6、8 h的镇痛程度,术后1、3、7 d的认知功能,术后血液生化指标8项[天冬氨酸氨基转移酶(alanine aminotransferase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、血尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,Scr)、总胆固醇(total cholesterol,TC)、三酰甘油(triacyl glycerol,TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)和低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)]及不良反应的发生情况。结果 试验组感觉阻滞起效时间、运动阻滞起效时间均短于对照组,感觉阻滞维持时间、运动阻滞维持时间均长于对照组(P<0.05);试验组患者麻醉后2、4、6、8 h的VAS显著低于对照组,术后1、3、7 d的MMSE评分显著高于对照组(P<0.05)。试验组的不良反应发生率(6.82%)明显低于对照组(18.18%),P<0.05。结论 右美托咪定联合臂神经丛麻醉用于肱骨干骨折老年患者麻醉效果和镇痛镇静效果更好,对认知功能的损伤较小,且安全性更高。

Objective To investigate the anesthesia effect of dexmedetomidine combined with brachial plexus anesthesia in elderly patients with humeral shaft fracture.Methods The elderly patients with humeral shaft fractures were selected as the research object and randomly divided into control group and experimental group,44 cases in each group.The control group was anesthetized with brachial plexus,and the experimental group was anesthetized with dexmedetomidine combined with brachial plexus.The anesthetic effect[the onset time of sensory block,the duration of sensory block,the onset time of motor block,and the duration of motor block],the degree of analgesia at 2,4,6 and 8 hours after anesthesia,the cognitive function on the 1,3,and 7 days after operation,8 postoperative blood biochemical indicators[aspartate aminotransferase(AST),alanine aminotransferase(ALT),blood urea nitrogen(BUN),serum creatinine(Scr),total cholesterol(TC),triacyl glycerol(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)]and the incidence of adverse reactions were compared between the 2 groups.Results The onset time of sensory block and the onset time of motor block in experimental group were lower than that in control group(P<0.05),while the maintenance time of sensory block and motor block were longer than in control group(P<0.05).The VAS of the patients in experimental group were lower than in control group at 2,4,6 and 8 hours after anesthesia(P<0.05),and the MMSE scores at 1,3 and 7 days after anesthesia was significantly higher than that in the control group(P<0.05).The incidence of adverse reactions in the experimental group(6.82%)was significantly lower than that in the control group(18.18%),P<0.05.Conclusion Dexmedetomidine combined with brachial plexus anesthesia for elderly patients with humeral shaft fracture can obtain better anesthesia effect and analgesia sedation effect,with less damage to cognitive function,less adverse reactions and higher safety.