Intravenous optimization effect of dexmedetomidine combined with low dose remifentanil on elderly patients undergoing hip arthroplasty
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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。 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. -
Key words:
- 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±12.52a 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±11.25ab 87.16±10.42ab 87.21±10.28ab 87.27±8.26ab 3.862 < 0.001 C组 30 93.71±11.34 88.98±11.19ab 84.98±11.22abc 84.29±10.32abc 84.18±9.24abc 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。 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±8.35a 76.47±8.66a 75.87±7.48a 75.28±6.75a 4.497 < 0.001 B组 30 81.33±8.65 77.58±8.18a 76.61±7.71a 76.21±7.26a 75.64±6.86a 3.986 < 0.001 C组 30 81.61±8.64 77.20±8.23a 71.65±7.86abc 72.01±6.97abc 71.37±6.91abc 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。 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±1.15a 20.27±1.56a 19.38±1.64a 18.69±1.26a 4.692 < 0.001 B组 30 23.57±1.61 16.12±1.25ab 16.21±1.76ab 15.89±1.72ab 15.44±1.58ab 4.475 < 0.001 C组 30 23.65±1.62 16.22±1.21ab 16.18±1.78ab 15.77±1.86ab 15.68±1.46ab 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。 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±0.07a 1.73±0.11a 1.55±0.15a 0.81±0.16a 4.197 < 0.001 B组 30 2.25±0.12 1.85±0.06a 1.71±0.13a 1.53±0.18a 0.85±0.21a 4.829 < 0.001 C组 30 2.27±0.17 1.63±0.05abc 1.45±0.22abc 1.25±0.17abc 0.45±0.12abc 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。 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±9.79a 85.75±8.95a 76.89±9.78a 75.72±9.25a 4.589 < 0.001 B组 30 94.12±9.76 91.85±9.77ab 89.76±9.86ab 85.75±9.96ab 83.67±9.31ab 4.197 < 0.001 C组 30 93.28±9.75 83.25±9.62abc 82.65±9.74abc 76.78±9.86ac 74.97±9.26ac 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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