摘要
目的 探究盐酸右美托咪定(Dex)对脊柱侧弯矫形术患者体感诱发电位、运动诱发电位以及术后疼痛的影响.方法 前瞻性选取2020年1月至2022年10月期间西南交通大学附属医院/成都市第三人民医院收治的134例重度脊柱侧弯患者作为研究对象,按照随机数字表法分为观察组、对照组,每组各67例.所有患者均给予静脉麻醉,观察组麻醉诱导前、术中均泵注盐酸Dex,对照组麻醉诱导前、术中泵注等量的0.9％氯化钠溶液.比较两组患者围术期相关指标(手术时间、术中输血量、术后苏醒时间以及住院时间),麻醉前、切皮、探察以及拔管时的血流动力学[心率、平均动脉压(MAP)];同时检测术中经颅电刺激运动诱发电位(TCeMEPs)、体感诱发电位(SEPs);比较两组患者的术后2、6、12、24 h的视觉疼痛模拟评分法(VAS),并观察术后并发症发生情况.结果 两组患者手术时间、住院时间比较,差异均无统计学意义(P＞0.05);观察组患者的术中出血量为(650.04±100.77)mL,低于对照组[(751.21±81.69)mL],苏醒时间为(10.51±2.81)min,长于对照组[(6.32±1.39)min],差异均有统计学意义(P＜0.05).观察组探察、拔管时刻的心率分别为(75.04±5.22)、(76.83±4.29)次/min,均低于对照组[(87.15±6.69)、(90.04±10.67)次/min],拔管时刻的MAP为(105.01±7.82)mmHg,低于对照组[(115.85±13.50)mmHg],差异均有统计学意义(P＜0.05).观察组术后 2、6 h 的 VAS 评分分别为(3.54±0.68)、(3.77±0.82)分,均低于对照组[(4.01±1.20)、(4.25± 0.90)分],差异均有统计学意义(P＜0.05).两组SEPs幅度下降、TCeMEPs波幅、潜伏期变化差异均无统计学意义(P＞0.05).两组的术后并发症总发生率比较,差异无统计学意义(P＞0.05).结论 盐酸Dex可降低患者术中血流动力学波动和术后疼痛,但会延长患者苏醒时间,对患者术后并发症以及神经电位变化并无影响.
Abstract
Objective To investigate the effects of dexmedetomidine hydrochloride(Dex)on somatosensory evoked potential,motor e-voked potential and postoperative pain in patients undergoing orthopedics for scoliosis.Methods A total of From January 2020 to October 2022,134 patients with severe scoliosis admitted to Affiliated Hospital Southwest Jiaotong University,the Third People's Hospital of Chengdu were pro-spectively selected as the study subjects.They were divided into the observation group and the control group according to the random number table method,with 67 patients in each group.All patients were given intraoperative total intravenous anesthesia(TIVA).The observation group was in-jected with Dex hydrochloride before and during anesthesia induction,and the control group was injected with the same amount of normal saline at the same time.The perioperative related indicators(operation time time,intraoperative blood transfusion volume,postoperative recovery time,and hospital stay),as well as the hemodynamics(heart rate,mean arterial pressure(MAP)before anesthesia,skin incision,exploration,and extuba-tion were compared between two groups of patients.At the same time,intraoperative transcranial electrical stimulation motor evoked potentials(TCeMEPs)and somatosensory evoked potentials(SEPs)were detected.The visual pain simulation scale(VAS)at 2,6,12,and 24 hours after surgery was compared between two groups of patients,and the incidence of postoperative complications was observed.Results There were no sta-tistically significant differences in the operation time,hospital stay between the two groups(P＞0.05);the intraoperative bleeding volume of the observation group patients was(650.04±100.77)mL,which was lower than that of the control group[(751.21±81.69)mL],and the recov-ery time was(10.51±2.81)min,which was longer than that of the control group[(6.32±1.39)min],the differences were statistically signif-icant(P＜0.05).The heart rates at the time of exploration and extubation in the observation group were(75.04±5.22)and(76.83±4.29)beats/min,respectively,which were lower than those in the control group[(87.15±6.69)and(90.04±10.67)beats/min],the MAP at the time of extubation was(105.01±7.82)mmHg,which was lower than that in the control group[(115.85±13.50)mmHg],the differences were statistically significant(P＜0.05).The VAS scores of the observation group at 2 and 6 hours after surgery were(3.54±0.68)and(3.77 ±0.82)points,respectively,which were lower than those of the control group[(4.01±1.20)and(4.25±0.90)points],and the differences were statistically significant(P＜0.05).There were no statistically significant differences in SEPs amplitude,TCeMEPs amplitude and latency between the two groups(P＞0.05).There was no statistically significant difference in the total incidence of postoperative complications between the two groups(P＞0.05).Conclusion Dex hydrochloride can reduce intraoperative hemodynamic fluctuation and postoperative pain,but can prolong the recovery time of patients,and has no effect on postoperative complications and nerve potential changes.
基金项目
四川省卫生健康委员会医学科技项目(21PJ142)
成都市卫生健康委员会医学科研课题(2022141)
维普
万方数据