摘要
目的临床行椎体成形术(percutaneous kyphoplasty,PKP)常采用局部麻醉,但可引发患者血液流变学变化,增加心血管疾病风险,故临床致力于寻找安全有效的麻醉方式,本研究旨在探讨小剂量右美托咪定联合舒芬太尼对老年腰椎骨折PKP患者血流动力学的影响。方法选择2018-04-16-2019-03-22本院收治的老年腰椎骨折拟行PKP患者78例为研究对象,根据性别、年龄、腰椎骨折部位组间具有均衡性的原则分为两组,每组各39例,对照组在麻醉前给予舒芬太尼静脉注射,观察组联合小剂量的右美托咪定。对比两组麻醉诱导前(T0)、麻醉诱导后(T1)、拔管时(T2)、拔管5min后(T3)及拔管30min后(T4)心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)和血氧饱和度(blood oxygen saturation,SpO2)情况;分析从T3到T4时间点,两组视觉模拟评分(visual analogue scale,VAS)和Ramsay评分状况。结果观察组T0、T1、T2、T3和T4时间点HR分别为(78.23±7.89)、(79.06±8.07)、(81.11±9.79)、(81.41±8.47)和(79.43±7.96)次/min,对照组分别为(78.26±8.17)、(79.18±8.02)、(95.12±9.94)、(92.06±9.68)和(79.82±7.97)次/min;观察组5个时间点MAP分别为(88.36±4.24)、(89.95±4.49)、(90.61±4.72)、(90.08±5.39)和(89.26±3.80)mm Hg,对照组分别为(88.63±4.51)、(90.53±4.70)、(99.02±5.01)、(96.76±4.81)和(89.27±4.48)mm Hg。双因素重复测量方差分析结果显示,观察组麻醉后HR(F组间=26.247,P<0.001)和MAP(F组间=24.532,P<0.001)水平低于对照组,差异有统计学意义,不同观察时间点HR(F时间=32.014,P<0.001)和MAP(F时间=30.265,P<0.001)水平差异有统计学意义,表现出由低到高,再逐渐恢复的变化规律,但观察组HR(F交互=52.087,P<0.001)和MAP(F交互=48.149,P<0.001)水平变化幅度远低于对照组,差异有统计学意义;SpO2水平组间和时间之间差异均无统计学意义,P>0.05。从T3到T4时间点,两组VAS和Ramsay评分均得到改善,但观察组改善的程度再两个时间点均高于对照组,差异有统计学意义,P<0.05。结论老年腰椎骨折PKP患者使用小剂量右美托咪定联合舒芬太尼可在麻醉苏醒期降低血压,稳定心率,起到良好的镇痛作用,效果高于单一使用舒芬太尼。
OBJECTIVE Local anesthesia is often used in clinical percutaneous kyphoplasty(PKP),but it can cause changes in hemorheology and increase the risk of cardiovascular disease.Therefore,clinical efforts are made to find safe and effective anesthesia methods.This study aims to investigate the effect of small dose of dexmedetomidine combined with sufentanil on hemodynamics in senile lumbar vertebra fracture patients with PKP.METHODS A total of 78 senile lumbar vertebra fracture patients with PKP who admitted in the hospital from April 16,2018 to March 22,2019 were selected as research objects.All patients were divided into two groups according to the gender,age,site of lumbar vertebra fracture,with 39 cases in each group.Control group was given intravenous injection of sufentanil before anesthesia,and observation group added small dose of dexmedetomidine.The heart rate(HR),mean arterial pressure(MAP)and blood oxygen saturation(SpO2)of the two groups before anesthesia induction(T0),after anesthesia induction(T1),at extubation(T2),after extubation(T3)and after extubation(T4)were compared,and the visual analog scale from T3 to T4 was analyzed.RESULTS HR of T0,T1,T2,T3 and T4 time points in the observation group was(78.23±7.89),(79.06±8.07),(81.11±9.79),(81.41±8.47)and(79.43±7.96)times/min,respectively,while that of the control group was(78.26±8.17),(79.18±8.02),(95.12±9.94),(92.06±9.68)and(79.82±7.97)times/min;The MAP of the five time points in the observation group was(88.36±4.24),(89.95±4.49),(90.61±4.72),(90.08±5.39)and(89.26±3.80)mm Hg,while that in the control group was(88.63±4.51),(90.53±4.70),(99.02±5.01),(96.76±4.81)and(89.27±4.48)mm Hg.The results of ANOVA showed that HR(F=26.247,P<0.001)and MAP(F=24.532,P<0.001)levels in the observation group were lower than those in the control group,and the differences were statistically significant.HR(F=32.014,P<0.001)and MAP(F=30.265,P<0.001)levels at different observation time points were statistically significant,showing agradual recovery from low to high However,HR(F=52.087,P<0.001)and MAP(F=48.149,P<0.001)levels in the observation group were significantly lower than those in the control group,and there was no significant difference between SpO2 levels and time(P>0.05).From T3 to T4,VAS and Ramsay scores of the two groups were improved,but the improvement degree of the observation group was higher than that of the control group at the other two time points,the difference was statistically significant(P<0.05).CONCLUSION Small dose of dexmedetomidine combined with sufentanil for senile lumbar vertebra fracture patients with PKP can decrease blood pressure during anesthesia recovery period,stabilize heart rate and achieve better analgesic effect,whose effect is higher than single use of sufentanil.
作者
魏海河
郝丽冉
WEI Hai-he;HAO Li-ran(Department of Anesthesiology,Nanyang Orthopedic Hospital in Henan Province,Nanyang473000,P.R.China)
出处
《社区医学杂志》
2019年第24期1593-1596,共4页
Journal Of Community Medicine
关键词
腰椎骨折
椎体成形术
右美托咪定
舒芬太尼
lumbar vertebra fracture
percutaneous kyphoplasty
dexmedetomidine
sufentanil
