| 王晨玉,陶振云,王雪,等.不同剂量右美托咪定联合椎管内麻醉用于老年髋关节置换术患者的效果[J].中国临床保健杂志,2022,25(6):793-796. |
| 不同剂量右美托咪定联合椎管内麻醉用于老年髋关节置换术患者的效果 |
| Influences of different doses of dexmedetomidine combined with spinal anesthesia on sedation effect and stress response in elderly patients undergoing hip replacement |
| 投稿时间：2022-10-08 |
| DOI：10.3969/J.issn.1672-6790.2022.06.016 |
| 中文关键词: 关节成形术,置换,髋 麻醉,传导 右美托咪定 剂量效应关系,药物 老年人 |
| 英文关键词: Arthroplasty,Replacement,hip Anesthesia,conduction Dexmedetomidine Dose-response relationship,drug Aged 〖FL |
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| 中文摘要: |
| 目的 探讨不同剂量右美托咪定联合椎管内麻醉用于老年髋关节置换手术患者对镇静效果及应激反应的影响。方法 以2020年3月至2022年3月189例老年髋关节置换手术患者为研究对象,采用随机数字表法分为高剂量组(94例)及低剂量组(95例)。2组均给予椎管内麻醉联合右美托咪定镇静,以右美托咪定负荷剂量0.5 μg/kg泵入10 min后,高剂量组及低剂量组分别以0.4、0.2 μg·kg-1·h-1维持剂量持续泵入。2组均于术毕前10 min停药。比较2组镇静效果,记录患者各时段的应激指标及认知功能相关指标,并于术后统计谵妄及不良反应发生情况。结果 高剂量组及低剂量组各时段的脑电双频指数(BIS)及警觉/镇静(OAA/S)评分比较,差异均无统计学意义(P>0.05)；低剂量组麻醉30 min及术闭即刻的去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)水平均低于高剂量组(P<0.05)；低剂量组术后3、5 d的S100B蛋白、髓鞘碱性蛋白(MBP)水平及术后3 d的神经元特异性烯醇化酶(NSE)水平低于高剂量组(P<0.05)；低剂量组、高剂量组的术后谵妄发生率及麻醉相关不良反应发生率比较,差异均无统计学意义(P>0.05)。结论 不同剂量右美托咪定联合椎管内麻醉用于老年髋关节置换手术的镇静效果相当,但低剂量右美托咪定联合麻醉可降低患者应激反应,并能减轻麻醉药物对认知功能的影响。 |
| 英文摘要: |
| Objective To explore the effects of different doses of dexmedetomidine combined with spinal anesthesia on sedation effect and stress response in elderly patients undergoing hip replacement.Methods A total of 189 elderly patients undergoing hip replacement were enrolled as the research objects between March 2020 and March 2022.According to random number table method,they were divided into high-dose group (n=94) and low-dose group (n=95).Both groups were given spinal anesthesia combined with dexmedetomidine sedation.After 10 min of dexmedetomidine (0.5 μg/kg) pumping,high-dose group and low-dose group were given 0.4 μg·kg-1·h-1 and 0.2 μg·kg-1·h-1 of dexmedetomidine,respectively.The sedation effect between the two groups was compared.The stress indexes and cognitive function-related indexes were recorded at different time periods.The occurrence of delirium and adverse reactions was statistically analyzed after surgery.Results There was no significant difference in bispectral index (BIS) or observer′s assessment of alertness/sedation (OAA/S) between the two groups (P>0.05).At 30 min after anesthesia and immediately after surgery,levels of norepinephrine (NE),epinephrine (E) and cortisol (Cor) in low-dose group were lower than those in high-dose group (P<0.05).The levels of S100B protein and myelin basic protein (MBP) at 3 d and 5 d after surgery,and level of neuron-specific enolase (NSE) at 3 d after surgery in low-dose group were lower than those in high-dose group (P<0.05).There was no significant difference in the incidence of postoperative delirium and anesthesia-related adverse reactions between the two groups (P>0.05).Conclusions Sedation effect of different doses of dexmedetomidine combined with spinal anesthesia is comparable in elderly patients undergoing hip replacement.However,low-dose dexmedetomidine combined with anesthesia can reduce stress level and effects of anesthetics on cognitive function. |
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