摘要
目的评价超声引导下腰骶丛神经阻滞复合小剂量右美托咪定镇静用于老年患者髋部骨折手术的安全性和有效性。方法择期行髋部骨折手术的患者40例，性别不限，年龄71～95岁，体重44～76kg，美国麻醉医师学会分级I至Ⅲ级，随机分入对照组和研究组，每组20例。对照组患者行常规气管插管静吸复合全身麻醉，研究组患者在超声引导下实施腰丛、骶丛神经阻滞后给予小剂量右美托咪定镇静。两组患者术后均应用患者静脉自控镇痛（PCIA）方式进行镇痛。记录两组手术中血管活性药物的使用次数和剂量。在术前（To）、气管插管或输注右美托咪定即刻（T1）、手术切皮即刻（T2），以及手术开始后10min（T3）、20rain（T4）、40min（T5）、60rain（T6）各时间点，记录患者的心率（HR）、平均动脉压（MAP）和脉搏血氧饱和度（SpO2）。记录术后6、8和24h的疼痛视觉模拟评分（VAS评分）。记录48hPCIA的用药总量、有效按压次数，以及术后恶心呕吐（PONV）和咽喉疼痛的发生情况。记录两组的麻醉费用。随访术后3个月病死率。结果对照组在T-至Ts时间点的HR均显著快于研究组同时间点（P值均〈0．01），MAP均显著高于研究组同时间点（P值均〈0．01）。两组间各时间点SpO2的差异均无统计学意义（P值均〉0．05）。对照组术中佩尔地平、麻黄碱的使用次数和剂量，术后48h PCIA的用药总量和有效按压次数均显著多于研究组（P值均〈0．01）。对照组术后各时间点的疼痛VAS评分均显著高于研究组同时间点（P值均〈0．01）。对照组的PONV和咽喉疼痛发生率、麻醉费用和术后3个月病死率均显著高于研究组（P值均〈0．01）。结论在超声引导下实施腰丛、骶丛神经阻滞复合小剂量右美托咪定镇静可以安全、有效地应用于老年患者髋部骨折手术，可以保持血流动力学稳定，并提供良好的术后镇痛和减少麻醉后的不良反应发生。
Objective To evaluate the safety and efficacy of ultrasound guided lumbosacral plexus block associated with sedation by low-dose dexmedetomidine in elderly patients with hip fracture. Methods Forty patients scheduled for hip fracture surgery, aged 71 - 95 years, weighing 44 - 76 kg, American Society of Anesthesiologists （ASA） Ⅰ to Ⅲ, were randomized into control group and study group （n = 20）. Traditional intravenous-inhalation combined anesthesia with endotracheal intubation （ETT） was performed in control group. Ultrasound guided lumbosacral plexus block and low-dose dexmedetomidine were given to patients in the study group. Patient controlled intravenous analgesia （PCIA） was conducted in both groups after surgery. Heart rate （HR）, mean artery pressure （MAP） and saturation pulse oxygen （SPO2） were recorded before surgery （T0）, immediately after ETT or dexmedetomidine infusion （T1）, immediately after cutting skin （T2） and at 10, 20, 40 and 60 min during surgery. Visual analog scale （VAS） scores on 6, 8 and 24 h postoperatively, dosage of 48-hour PCIA, and frequencies of PCIA effective pressing as well as incidence of post-operative nausea and vomiting （PONV） and pharyngalgia were recorded. The use of vasoactive agent during operation, the cost of anesthesia and case fatality rate during 3-month follow-up were also recorded. Results Both HR and MAP in control group from T1 to Tswere significantly higher than those in study group （all P〈0.01）, but there was no significant difference in SpO2 between the two groups during operation （all P〉0.05）. The dosage of vasoactive agent （perdipine and ephedrine） during operation, the dosage of 48-hour PCIA, and the frequencies of PCIA effective pressing in control group were much more than those in study group （all P〈0.01）. The VAS scores, the incidences of PONV and pharyngalgia, the cost of anesthesia and case fatality rate in control group were all significantly higher than those in study group （all P〈0.01 ）. Conclusion Ultrasound guided lumbosacral plexus block combined with low-dose dexmedetomidine infusion is safe and effective in hip fracture surgery. This pattern of anesthesia can provide stable hemodynamics, good analgesia and reduce adverse events caused by anesthesia. （Shanghai Med J, 2014, 37= 657-661 ）
出处
《上海医学》
CAS
CSCD
北大核心
2014年第8期657-661,I0001,共6页
Shanghai Medical Journal
