摘要
目的探讨右美托咪定静脉麻醉联合局部麻醉用于高龄(年龄≥80岁)胸腰椎骨折患者经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)的有效性与安全性。方法选择行PKP的高龄骨质疏松性椎体压缩性骨折患者36例,根据是否联合静脉麻醉分为静脉麻醉联合局部麻醉组(观察组)19例和局部麻醉组(对照组)17例。观察组术中采用静脉泵入右美托咪定,麻醉前10 min以0.5μg/kg负荷剂量静脉给药,并以0.4μg·kg^(-1)·h^(-1)维持剂量至手术结束;2组均采用1.0%利多卡因局部浸润麻醉,总量40 mL。记录2组手术时间和围手术期疼痛管理的满意度评分,观察2组患者术前(T0)、局部麻醉时(T1)、穿刺入椎体时(T2)、球囊扩张时(T3)、注入骨水泥时(T4)、手术结束时(T5)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度(blood oxygen saturation,SpO2)、疼痛视觉模拟评分(visual analogue scale,VAS),记录2组麻醉相关不良反应和并发症发生情况。结果2组手术时间差异无统计学意义(P>0.05);观察组围手术期疼痛管理满意度评高于对照组,差异有统计学意义(P<0.05)。2组患者MAP、HR、VAS评分变化趋势波动,观察组患者MAP、HR、VAS评分低于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05);2组SpO2时点间差异有统计学意义(P<0.05),组间、组间·时点间交互作用差异无统计学意义(P>0.05)。围手术期2组均未发生心动过缓,血氧下降、血压波动等麻醉相关并发症。2组骨水泥渗漏发生率差异无统计学意义(P>0.05)。结论小剂量右美托咪定静脉麻醉联合局部麻醉为高龄PKP患者提供了一种安全、有效的麻醉方案,能有效降低围手术期血流动力学反应。
Objective To explore the effectiveness and safety of dexmedetomidine combined with local anesthesia for percutaneous kyphoplasty(PKP)in the treatment of elderly patients(age≥80 years)with thoracolumbar fractures.Methods A total of 36 elderly patients with osteoporotic vertebral compression fractures who were selected for PKP were divided into intravenous anesthesia combined with local anesthesia group(observation group,n=19)and local anesthesia group(control group,n=17)according to presence or absence of combined intravenous anesthesia.In the observation group,intravenous pumping of dexmedetomidine was used during the operation,followed by intravenous administration at a loading dose of 0.5μg/kg 10 min before anesthesia,and 0.4μg·kg^(-1)·h^(-1)maintenance dose until the end of the operation.Both groups were anesthetized with 1.0%lidocaine for local infiltration,with a total volume of 40 mL.The duration of operation and satisfaction score of perioperative pain management in both groups were recorded.Mean arterial pressure(MAP),heart rate(HR),blood oxygen saturation(SpO2)and pain visual analogue scale(VAS)score before operation(T0),during local anesthesia(T1),during puncture into the vertebral body(T2),during balloon expansion(T3),during injection of bone cement(T4),and at the end of surgery(T5)of the two groups were recorded.The occurrence of anesthesia-related adverse reactions and complications was recorded.Results There was no statistically significant difference in duration of operation between the two groups(P>0.05).Satisfaction score of perioperative pain management was higher in observation group than in the control group,and the difference was statistically significant(P<0.05).The MAP,HR,and VAS scores of the two groups fluctuated.The MAP,HR,and VAS scores of the observation group were lower than those of the control group.The differences in the interaction between groups,time points,and time points between groups were statistically significant(P<0.05);the time points in SpO2 between two groups were statistically significant(P<0.05),and there was no statistically significant difference in SpO2 in the interaction between groups,and time points between groups(P>0.05).During the perioperative period,there were no anesthesia-related complications such as bradycardia,hypoxemia,and blood pressure fluctuations in the two groups.There was no significant difference in the incidence of bone cement leakage between the two groups(P>0.05).Conclusion Low-dose dexmedetomidine combined with local anesthesia provides a safe and effective anesthesia program for elderly patients with PKP,which can effectively reduce the hemodynamic response during perioperative period.
作者
张沛
杜源
王思迪
孙承军
金祺
ZHANG Pei;DU Yuan;WANG Si-di;SUN Cheng-jun;JIN Qi(Department of Orthopedics, China Resources Wisco General Hospital, Wuhan University of Science and Technology, Hubei Province, Wuhan 430080, China)
出处
《河北医科大学学报》
CAS
2021年第11期1328-1332,共5页
Journal of Hebei Medical University
基金
湖北省卫生和计划生育委员会联合基金项目(WJ2018H0124)。
关键词
脊柱骨折
椎体后凸成形术
麻醉
静脉
麻醉
局部
spinal fractures
kyphoplasty
anesthesia
intravenous
anesthesia
local
