右美托咪定复合小剂量瑞芬太尼在老年患者髋关节置换术中的静脉优化效应

刘卢; 梁苏荣; 潘在礼; 许环航

doi:10.16766/j.cnki.issn.1674-4152.002411

右美托咪定复合小剂量瑞芬太尼在老年患者髋关节置换术中的静脉优化效应

doi: 10.16766/j.cnki.issn.1674-4152.002411

1.
文昌市人民医院麻醉科, 海南文昌 573100
2.
儋州市第一人民医院麻醉科，海南儋州 571700

基金项目:

海南省卫生计生科研项目 2018175

详细信息

通讯作者:
刘卢，E-mail：jintianchii@163.com

中图分类号: R684 R614.4
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- 被引次数: 0
出版历程
- 收稿日期: 2021-04-10
- 网络出版日期: 2022-08-20

Intravenous optimization effect of dexmedetomidine combined with low dose remifentanil on elderly patients undergoing hip arthroplasty

1.
Department of Anesthesiology, Wenchang People ' s Hospital, Wenchang, Hainan 571300, China

摘要

摘要: 目的探讨右美托咪定(DEX)复合小剂量瑞芬太尼对腰丛-坐骨神经阻滞下老年髋关节置换术患者术中的静脉优化效应。方法选取2018年7月—2020年7月在文昌市人民医院行髋关节置换术的老年患者90例，采用随机对照表法分为A组、B组和C组，每组30例。A组给予DEX泵注，B组给予小剂量瑞芬太尼泵注，C组给予小剂量瑞芬太尼持续泵注的同时联合DEX泵注，泵注剂量与A、B组相同。各组均在用药10 min后在超声联合神经刺激引导下行腰丛-坐骨神经阻滞。观察并比较各组血流动力学、镇痛和镇静效果，比较患者对麻醉效果的满意度。结果在神经阻滞后(T1)，B、C组MAP明显低于A组(均P < 0.05)；在手术开始后15 min(T2)、手术开始后30 min(T3)及手术完成时(T4)，C组MAP明显低于A组和B组(均P < 0.05)，B组MAP明显低于A组(均P < 0.05)；在T2~T4时，C组HR明显低于A组和B组(均P < 0.05)。在T1~T4时，B、C组RR明显低于A组(均P < 0.05)。在T1~T4时，C组VAS评分明显低于A组和B组(均P < 0.05)；T1~T2时，C组BIS明显低于A、B组(均P < 0.01)，A组BIS明显低于B组(均P < 0.05)；T3~T4时，B组BIS明显高于A组和C组(均P < 0.05)。C组患者对麻醉满意度(96.67%)明显高于A组(66.67%)和B组(66.67%，χ²=9.017，P=0.003)。结论对腰丛-坐骨神经阻滞麻醉下的老年髋关节置换术患者，在术中给予DEX联合小剂量瑞芬太尼持续泵注，能有效维持血流动力学稳定，并能提供更佳的镇痛和镇静效果，且不良反应小，值得在临床推广使用。
- 右美托咪定 /
- 瑞芬太尼 /
- 老年髋关节置换术 /
- 腰丛-坐骨神经阻滞 /
- 静脉优化效应
Abstract: Objective To investigate the anesthetic effect of dexmedetomidine (DEX) combined with low dose remifentanil on elderly patients undergoing hip arthroplasty with lumbar plexus-sciatic nerve block. Methods A total of 90 elderly patients undergoing hip arthroplasty in our hospital from July 2018 to July 2020 were randomly divided into group A, B and C, with 30 patients in each group. Group A was given DEX pump injection, group B was given small dose remifentanil pump injection, group C was given small dose remifentanil continuous pump injection combined with DEX pump injection, the injection dose was the same as that of group A and B. All groups were treated with lumbar plexus-sciatic nerve block guided by ultrasound combined with nerve stimulation 10 minutes after administration. Hemodynamics, analgesia and sedation effects were observed and compared in each group, and patients ' satisfaction with anesthesia effect was compared. Results After nerve block (T1), MAP of group B and C was significantly lower than that of group A (all P < 0.05). At 15min (T2), 30 min (T3) after operation and operation completion (T4), the MAP of group C was significantly lower than that of groups A and B (all P < 0.05), and that of group B was significantly lower than that of group A (all P < 0.05). At T2-T4, HR in group C was significantly lower than that in groups A and B (all P < 0.05). At T1-T4, RR in groups B and C was significantly lower than that in group A (all P < 0.05). At T1-T4, VAS score in group C was significantly lower than that in groups A and B (all P < 0.01). At T1-T2, BIS in group C was significantly lower than that in groups A and B (all P < 0.01), and BIS in group A was significantly lower than that in group B (all P < 0.05). At T3-T4, BIS in group B was significantly higher than that in group A and C (all P < 0.01). The anesthesia satisfaction of group C (96.67%) was significantly higher than that of group A (66.67%) and B (66.67%, χ²=9.017, P=0.003). Conclusion In elderly patients undergoing hip replacement under lumbar plexus-sciatic nerve block anesthesia, intraoperative administration of DEX combined with low-dose remifentanil continuous pumping can effectively maintain hemodynamic stability, and provide better analgesia and sedative effects, with small adverse reactions, which is worthy of clinical promotion.
- Dexmedetomidine /
- Remifentanil /
- Hip replacement in the elderly /
- Anesthesia effect

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表 1 3组髋关节置换术患者不同时间点MAP比较(x±s，mm Hg)

Table 1. Comparison of MAP at different time points in three groups of patients undergoing hip arthroplasty (x±s, mm Hg)

组别	例数	T0	T1	T2	T3	T4	F值	P值
A组	30	93.87±11.32	101.36±12.52^a	92.62±10.23	91.92±11.27	91.63±9.35	4.391	< 0.001
B组	30	93.82±11.21	89.15±11.25^ab	87.16±10.42^ab	87.21±10.28^ab	87.27±8.26^ab	3.862	< 0.001
C组	30	93.71±11.34	88.98±11.19^ab	84.98±11.22^abc	84.29±10.32^abc	84.18±9.24^abc	3.498	< 0.001
F值		0.002	11.102	4.111	3.933	5.231
P值		0.998	< 0.001	0.002	0.023	0.007
注：各组内与T0时比较，^aP < 0.05；与A组比较，^bP < 0.05；与B组比较，^cP < 0.05。

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表 2 3组髋关节置换术患者不同时间点HR比较(x±s，次/min)

Table 2. Comparison of HR at different time points in three groups of hip replacement patients (x±s, times/min)

组别	例数	T0	T1	T2	T3	T4	F值	P值
A组	30	82.53±8.63	78.12±8.35^a	76.47±8.66^a	75.87±7.48^a	75.28±6.75^a	4.497	< 0.001
B组	30	81.33±8.65	77.58±8.18^a	76.61±7.71^a	76.21±7.26^a	75.64±6.86^a	3.986	< 0.001
C组	30	81.61±8.64	77.20±8.23^a	71.65±7.86^abc	72.01±6.97^abc	71.37±6.91^abc	3.591	< 0.001
F值		0.158	0.056	3.658	3.115	3.596
P值		0.854	0.946	0.030	0.049	0.032
注：各组内与T0时比较，^aP < 0.05；与A组比较，^bP < 0.05；与B组比较，^cP < 0.05。

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表 3 3组髋关节置换术患者不同时间点RR比较(x±s，次/min)

Table 3. Comparison of RR at different time points in three groups of patients undergoing hip arthroplasty (x±s, times/min)

组别	例数	T0	T1	T2	T3	T4	F值	P值
A组	30	23.52±1.42	19.37±1.15^a	20.27±1.56^a	19.38±1.64^a	18.69±1.26^a	4.692	< 0.001
B组	30	23.57±1.61	16.12±1.25^ab	16.21±1.76^ab	15.89±1.72^ab	15.44±1.58^ab	4.475	< 0.001
C组	30	23.65±1.62	16.22±1.21^ab	16.18±1.78^ab	15.77±1.86^ab	15.68±1.46^ab	4.875	< 0.001
F值		0.054	70.687	57.266	41.548	89.995
P值		0.947	< 0.001	< 0.001	< 0.001	< 0.001
注：各组内与T0时比较，^aP < 0.05；与A组比较，^bP < 0.05。

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表 4 3组髋关节置换术患者不同时间点VAS评分比较(x±s，分)

Table 4. Comparison of VAS scores at different time points in three groups of hip replacement patients (x±s, points)

组别	例数	T0	T1	T2	T3	T4	F值	P值
A组	30	2.31±0.16	1.95±0.07^a	1.73±0.11^a	1.55±0.15^a	0.81±0.16^a	4.197	< 0.001
B组	30	2.25±0.12	1.85±0.06^a	1.71±0.13^a	1.53±0.18^a	0.85±0.21^a	4.829	< 0.001
C组	30	2.27±0.17	1.63±0.05^abc	1.45±0.22^abc	1.25±0.17^abc	0.45±0.12^abc	4.989	< 0.001
F值		1.219	219.273	28.372	30.215	51.938
P值		0.301	< 0.001	< 0.001	< 0.001	< 0.001
注：各组内与T0时比较，^aP < 0.05；与A组比较，^bP < 0.05；与B组比较，^cP < 0.05。

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表 5 3组髋关节置换术患者不同时间点BIS比较(x±s)

Table 5. Comparison of BIS at different time points in three groups of hip arthroplasty patients (x±s)

组别	例数	T0	T1	T2	T3	T4	F值	P值
A组	30	93.68±9.73	86.63±9.79^a	85.75±8.95^a	76.89±9.78^a	75.72±9.25^a	4.589	< 0.001
B组	30	94.12±9.76	91.85±9.77^ab	89.76±9.86^ab	85.75±9.96^ab	83.67±9.31^ab	4.197	< 0.001
C组	30	93.28±9.75	83.25±9.62^abc	82.65±9.74^abc	76.78±9.86^ac	74.97±9.26^ac	4.691	< 0.001
F值		0.056	5.903	4.202	8.184	8.108
P值		0.946	0.004	0.018	0.001	0.001
注：各组内与T0时比较，^aP < 0.05；与A组比较，^bP < 0.05；与B组比较，^cP < 0.05。

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