经中心静脉持续泵注小剂量去甲肾上腺素对老年股骨粗隆间骨折手术患者血流动力学、术中血管活性药物用量及术后认知功能的影响

Effects of continuous infusion of low-dose norepinephrine via central vein on hemodynamics,intraoperative vasoactive drug dosage and postoperative cognitive function in elderly patients undergoing intertrochanteric fracture surgery

目的探究经中心静脉持续泵注小剂量去甲肾上腺素对老年股骨粗隆间骨折手术患者血流动力学、术中血管活性药物用量及术后认知功能的影响,为治疗该病症提供方法。方法回顾性分析2021年8月—2024年1月亳州市中医院收治的94例行股骨粗隆间骨折手术的摔伤性骨折患者的临床资料,按照1∶1临近匹配法进行匹配,观察组和对照组各40例。2组患者均于术中经中心静脉泵注0.010.05μg/(kg·min)的小剂量去甲肾上腺素,其中观察组采取持续泵注法,对照组采取间歇泵注法。记录并比较2组患者麻醉不良反应发生情况、术中去甲肾上腺素用量和出血量;比较术中不同时刻[入室麻醉开始前(T0)、麻醉开始后5 min(T1)、手术切皮前(T2)、手术切皮后5 min(T3)、手术切皮后30 min(T4)、术毕(T5)]患者血流动力学指标值[平均动脉压(MAP)和心率(HR)];比较术后患者的疼痛情况[采用视觉模拟评分(VAS)评估]、手术前后的认知功能[采用蒙特利尔量表(MoCA)评分]。结果术后观察组不良反应总发生率与对照组差异无统计学意义(7.50%vs 25.00%,P>0.05);观察组去甲肾上腺素用量高于对照组,出血量均低于对照组(P<0.05);术后6、12、24、48和72 h,观察组VAS评分均低于对照组(P<0.05);术后6 h、24 h、2 d、3 d和7 d,观察组患者MoCA评分均高于对照组(P<0.05);T0时刻,2组患者MAP和HR差异均无统计学意义(P>0.05);T1、T2、T3、T4和T5时刻,2组患者MAP和HR值均在正常值范围内升高,且观察组患者MAP和HR值均低于对照组(P<0.05)。结论经中心静脉持续泵注小剂量去甲肾上腺素对股骨粗隆间骨折手术患者血流动力学和术后认知功能影响小,且具有一定的镇痛效果。

Objective To explore the effects of continuous infusion of low-dose norepinephrine via central vein on hemodynamics,intraoperative vasoactive drug dosage and postoperative cognitive function in elderly patients undergoing intertrochanteric fracture surgery,and provide methods for the treatment of this condition.Methods The clinical data of 94 patients with fall fracture who underwent intertrochanteric fracture surgery in Hospital of Traditional Chinese Medicine of Bozhou City from August 2021 to January 2024 were retrospectively analyzed.According to 1∶1 proximity matching method,they were divided into observation group and control group,with 40 cases in each group.Both groups of patients received infusion of low-dose norepinephrine[0.01--0.05μg/(kg·min)]via central venous pump during surgery.However,the observation group adopted continuous pumping method,while the control group adopted intermittent pumping method.The incidence of anesthesia adverse reactions,intraoperative dosage of norepinephrine and blood loss in the two groups were recorded and compared.The hemodynamic index values[mean arterial pressure(MAP)and heart rate(HR)]of the two groups were compared at different times[before anesthesia(T0),5 min after anesthesia(T1),before skin incision(T2),5 min after skin incision(T3),30 min after skin incision(T4),and after surgery(T5)]during surgery.The postoperative pain levels[assessed by Visual Analogue Scale(VAS)]and cognitive function[assessed by Montreal Scale(MoCA)]before and after surgery were compared between the two groups.Results There was no significant difference in the total incidence of adverse reactions between the observation group and the control group(7.50%vs 25.00%,P>0.05).The intraoperative dosage of norepinephrine was higher than that of control group,and blood loss in the observation group was lower than that of control group(P<0.05).At 6,12,24,48 and 72 h after surgery,the VAS scores of the observation group were lower than those of the control group(P<0.05).At 6 h,24 h,2 d,3 d and 7 d after surgery,the MoCA scores of the observation group were higher than those of the control group(P<0.05).At T0,there was no significant difference in MAP and HR between the two groups(P>0.05).At T1,T2,T3,T4,and T5,the MAP and HR of both groups increased within the normal range,and the observation group were lower than the control group(P<0.05).Conclusion Continuous infusion of low-dose norepinephrine via central vein has little effect on hemodynamics and postoperative cognitive function in patients undergoing intertrochanteric fracture surgery,and has a certain analgesic effect.