摘要
目的观察地佐辛联合瑞芬太尼靶控输注对肱骨关节手术患者血流动力学、应激和认知功能的影响。方法选择2017-2019年在该院择期行钢板内固定肱骨中下段骨折的老年患者90例为研究对象,根据麻醉用药方案不同将患者分为观察组和对照组,每组45例。对照组予以瑞芬太尼靶控输注麻醉,观察组在对照组的基础上麻醉加用地佐辛。观察两组在麻醉诱导前(T0)、切开皮肤时(T1)、术毕前30 min(T2)、拔除气管导管即刻(T3)和拔除气管导管后30 min(T4)各个时点平均动脉压(MAP)、心率(HR)、去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(COR)、脑血流/脑氧代谢比值(CBF/CMRO_(2))、脑氧摄取率(CE-RO_(2))和动脉-颈静脉血氧含量差(Ca-jvO_(2))水平的变化,比较两组术后复苏时间,以及两组在术前,术后1、3、5、7 d的简易精神状态量表(MMSE)分数,神经元特异性烯醇化酶(NSE)和人S100B蛋白(S100B)水平的变化。结果两组在T0时点的MAP和HR差异无统计学意义(P>0.05),在T1—T4时点观察组的MAP和HR水平明显高于对照组(P<0.01)。两组在T0时点的NE、E、COR、CBF/CMRO_(2)、CE-RO_(2)和Ca-jvO_(2)水平差异无统计学意义(P>0.05),两组在T1—T4时点的NE、E、COR和CBF/CMRO_(2)水平均较T0时点明显升高,而CE-RO_(2)和Ca-jvO_(2)水平较T0时点出现明显降低(P<0.01),对照组NE、E和COR水平升高较观察组更明显,观察组CBF/CMRO_(2)水平升高较对照组更明显,CE-RO_(2)和Ca-jvO_(2)水平降低较对照组更明显(P<0.01)。两组在术前MMSE、NSE和S100B水平差异无统计学意义(P>0.05);手术后两组的MMSE分数均较术前明显降低,对照组水平降低更明显(P<0.01);两组NSE和S100B水平较术前明显升高(P<0.01),而对照组水平升高较对照组更为明显(P<0.01)。两组术后苏醒时间、拔除气管插管时间和离开复苏室时间差异无统计学意义(P>0.05)。结论地佐辛联合瑞芬太尼靶控输注麻醉肱骨手术老年患者,能够稳定机体血流动力学、降低机体的应激水平和改善脑氧供应,值得临床推广。
Objective To observe the impact of dezocine combined with target-controlled infusion of remifentanil on hemodynamics,stress and cognitive function in elderly patients with humerus fracture surgery.Methods A total of 90 patients aged from 2017 tO_(2)019 who underwent plate internal fixation of middle and lower humerus fractures in Shanghai Eighth People′s Hospital were selected.According to the different anesthesia medication plan,the patients were divided into observation group and control group,each group had 45 cases.The control group was anesthetized with target-controlled infusion of remifentanil,and the observation group was anesthetized with dezocine on the basis of the control group.The mean arterial pressure(MAP),heart rate(HR),norepinephrine(NE),epinephrine(E),cortisol(COR),cerebral blood flow/cerebral oxygen metabolism ratio(CBF/CMRO_(2)),cerebral oxygen uptake rate(CE-RO_(2))and arterial-jugular vein blood oxygen content(Ca-jvO_(2))levels were observed in two groups at each time point of before induction of anesthesia(T0),skin incision(T1),30 min before surgery(T2),immediate tracheal tube removal(T3),and 30 min after tracheal tube removal(T4),the postoperative recovery time was also compared in two groups,and the mini-mental state examination(MMSE),neuron specific enolase(NSE)and S100B protein(S100B)levels were also compared in two groups before surgery,1,3,5 and 7 d after surgery.Results There was no significant difference on MAP and HR between two groups at time point of T0(P>0.05),and MAP and HR levels in observation group were significantly higher than those in control group at time point of T1-T4(P<0.01).There was no significant difference on NE,E,COR,CBF/CMRO_(2),CE-RO_(2),and Ca-jvO_(2)levels between two groups at time point of T0(P>0.05),the levels of NE,E,COR and CBF/CMRO_(2)at time point of T1-T4 were significantly higher compared with the T0 time point(P<0.01),while CE-RO_(2)and Ca-jvO_(2)levels were significantly lower compared with the T0 time point(P<0.01),while the increasing or decreasing levels in control group were more obvious compared with the observation group(P<0.01).There was no significant difference on MMSE,NSE,and S100B levels between the two groups before surgery(P>0.05),after surgery the MMSE levels in two groups were significantly lower than before surgery(P<0.01),and the levels of NSE and S100B were significantly higher than before surgery(P<0.01),while the decreasing or increasing levels in control group were more obvious compared with the control group(P<0.01).There was no statistically significant difference between the two groups in postoperative wake-up time,tracheal intubation time and time to leave the resuscitation room(P>0.05).Conclusion Dezocine and remifentanil target-controlled infusion in elderly patients undergoing humerus fracture surgery can stabilize the body′s hemodynamics,reduce the body′s stress level,and improve cerebral oxygen supply,which is worthy of clinical promotion.
作者
周懿之
朱海峰
ZHOU Yizhi;ZHU Haifeng(Department of Anesthesiology,Shanghai Eighth People′s Hospital,Shanghai 200235,China)
出处
《检验医学与临床》
CAS
2021年第13期1894-1898,共5页
Laboratory Medicine and Clinic
关键词
地佐辛
瑞芬太尼
靶控输注
老年
应激
认知功能
dizocine
remifentanil
target-controlled infusion
elderly
stress
cognitive function
