摘要
目的探讨术前超声引导下右美托咪定联合罗哌卡因髂筋膜间隙阻滞对老年髋部骨折患者围术期镇痛及睡眠质量的影响。方法选取拟于椎管内麻醉下行髋部骨折手术的老年患者69例,采用随机数字表法分为两组:右美托咪定联合罗哌卡因髂筋膜间隙阻滞组(A组,n=35)和单纯罗哌卡因髂筋膜间隙阻滞组(B组,n=34)。两组患者术前1 d在超声引导下行患侧髂筋膜间隙阻滞,A组使用1.0μg/kg右美托咪定联合罗哌卡因,B组单纯使用罗哌卡因。记录两组患者髂筋膜间隙阻滞前(T_(0))、髂筋膜间隙阻滞后10 min(T_(1))、髂筋膜间隙阻滞后30 min(T_(2))、入手术室时(T_(3))、过手术床时(T_(4))、摆体位时(T_(5))各时间点的MAP、收率(HR)、脉搏血氧饱和度(SpO 2)和疼痛视觉模拟评分(VAS);记录术前1 d、手术当日、术后1 d、术后2 d、术后3 d患者夜间里兹睡眠问卷评分(LSEQ);记录术后7 d内谵妄、低血压、心动过缓、恶心呕吐、补救镇痛等不良反应发生率。结果与T_(0)时比较,A组T_(1)~T_(5)时MAP明显下降、HR明显减慢,VAS评分明显降低,B组T_(2)~T_(3)时MAP明显下降、HR明显减慢,VAS评分明显降低(P<0.05);与B组比较,A组T_(1)、T_(4)、T_(5)时,MAP明显下降、HR明显减慢,VAS评分明显降低(P<0.05);与术前1 d比较,A组手术当日、术后1 d、术后2 d、术后3 d LSEQ评分明显升高,B组手术当日LSEQ评分明显升高(P<0.05);与B组比较,A组手术当日、术后1 d、术后2 d、术后3 d LSEQ评分明显高于B组(P<0.05);与B组比较,A组围术期谵妄、恶心呕吐、补救镇痛发生率明显降低,而低血压、心动过缓发生率明显升高(P<0.05)。结论老年髋部骨折患者术前超声引导下1.0μg/kg右美托咪定联合罗哌卡因髂筋膜间隙阻滞可使患者术前血流动力学平稳,提高围术期镇痛效果,改善睡眠质量,降低围术期谵妄、恶心呕吐发生率。
Objective To investigate the effect of preoperative ultrasound-guided dexmedetomidine combined with ropivacaine fascia iliaca compartment block on perioperative analgesia and sleep quality in elderly patients with hip fracture.Methods A total of 69 elderly patients undergoing hip fracture surgery under spinal-epidural anesthesia were enrolled and divided into the two groups by the random number table method:the dexmedetomidine combined with ropivacaine fascia iliaca compartment block group(group A,n=35)and the simple ropivacaine fascia iliaca compartment block group(group B,n=34).The patients in the both groups received ultrasond-guided fascia iliaca compartment block in the affected side on 1 d before surgery,the group A received 1.0μg/kg dexmedetomidine combined with ropivacaine,while the group B received ropivacaine alone.The mean arterial pressure(MAP),heart rate(HR),pulse blood oxygen saturation(SpO_(2))and pain visual analogue scores(VAS)before iliac space block(T_(0)),at 10 min after iliac space block(T_(1)),30 min after iliac space block(T_(2)),entering the operating room(T_(3)),passing the operating bed(T_(4))and positioning(T_(5))were recorded.The Leed sleep evaluation questionnaire(LSEQ)score was recorded on the day before surgery,the day of surgery,and 1,2,3 d after surgery.The incidence rates of adverse reactions such as delirium,hypotension,bradycardia,nausea and vomiting and remedial analgesia were recorded within 7 d after surgery.Results Compared with at T_(0),MAP,HR and VAS score at T_(1)-T_(5) in the group A were decreased sig-nificantly,MAP at T_(2)-T_(3) in the group B was significantly decreased,HR was significantly slowed and the VAS score was significantly decreased(P<0.05).Compared with group B,MAP,HR and VAS scores at T_(1),T_(4) and T_(5) in the group A were significantly decreased(P<0.05).Compared with the LESQ on the day before operation,the LSEQ scores on the day of operation,postoperative 1,2,3 d in group A were increased significantly,and that on the day of operation,in group B was significantly increased(P<0.05).Compared with group B,the LSEQ scores on the day of operation,postoperative 1,2,3 d in group A were significantly higher than those in group B(P<0.05).Compared with group B,the incidence rates of perioperative delirium,nausea and vomiting and remedial analgesia in group A were significantly decreased,while the incidence rates of hypotension and bradycardia were significantly increased(P<0.05).Conclusion Preoperative ultrasound-guided 1.0μg/kg dexmedetomidine combined with ropivacaine fascia iliaca compartment block could make preoperative hemodynamics more stable,enhance perioperative analgesia effect,improve sleep quality,and reduce the incidence arte of nausea and vomiting during perioperative period in elderly patients with hip fracture.
作者
汪宏
鲁汉杰
周丹
谈世刚
宋晓阳
WANG Hong;LU Hanjie;ZHOU Dan;TAN Shigang;SONG Xiaoyang(Department of Anesthesiology,Central Theater General Hospital,Wuhan,Hubei 430070,China)
出处
《重庆医学》
CAS
2023年第22期3465-3469,共5页
Chongqing medicine
