摘要
目的 探讨亚麻醉剂量艾司氯胺酮联合右美托咪定对骨质疏松性椎体压缩性骨折(OVCF)患者术中镇静镇痛效果及安全性的影响.方法 选取 2020 年 10 月—2022 年 12 月收治的行椎体成形术的OVCF 101 例.根据麻醉药物不同将其分为研究组(51 例)和对照组(50 例)2 组.研究组采用亚麻醉剂量艾司氯胺酮联合右美托咪定进行麻醉,对照组采用舒芬太尼联合右美托咪定进行麻醉.比较 2 组手术情况,入室时、切皮时(T1)、注入骨水泥时(T2)、手术结束时(T3)呼吸循环指标[心率、平均动脉压(MAP)、血氧饱和度、呼吸]、疼痛[视觉模拟评分法(VAS)评分]和警觉镇静程度[警觉镇静量表(OAA/S)评分]、应激指标[醛固酮(ALD)、皮质醇(Cor)、去甲肾上腺素(NE)],术后舒适度[(舒适度评分(BCS)]和认知功能(简明精神状态量表),以及术中不良反应.结果 2 组手术情况比较差异无统计学意义(P＞0.05).T1、T2、T3 时,研究组心率、MAP、呼吸、VAS评分、OAA/S评分及血清ALD、Cor、NE低于对照组(P＜0.05,P＜0.01).术后3、12、24 和48 h,研究组BCS高于对照组(P＜0.01).术中,研究组和对照组不良反应总发生率比较差异无统计学意义(13/51,25.49%vs 18/50,36.00%;P＞0.05).结论 OVCF椎体成形术患者采用亚麻醉剂量艾司氯胺酮联合右美托咪定进行麻醉能减轻应激反应,稳定呼吸循环,且镇静镇痛作用良好,安全性较高.
Abstract
Objective To investigate the effects of subanesthetic Esketamine combined with Dexmedetomidine on in-traoperative sedation,analgesia and safety in patients with osteoporotic vertebral compression fracture(OVCF).Methods A total of 101 patients with OVCF who underwent vertebroplasty from October 2020 to December 2022 were selected.According to the different narcotic drugs,they were divided into two groups:research group(n =51)and control group(n =50).The subanesthetic dose of Esketamine combined with Dexmedetomidine was administered in the research group,and Sufentanil combined with Dexmedetomidine was administered in the control group.The surgical conditions of the two groups were com-pared.Respiratory circulatory indicators[heart rate,mean arterial pressure(MAP),oxygen saturation,respiration],pain[Visual Analogue Scale(VAS)score]and alert sedation[Observer's Assessment of Alertness/Sedation Scale(OAA/S)score],stress indicators[aldosterone(ALD),cortisol(Cor),norepinephrine(NE)],postoperative comfort[Bruggman Comfort Score(BCS)]and cognitive function[Mini-mental State Examination(MMSE)]at the time of entry,incision(T1),bone cement injection(T2),and at the end of surgery(T3)and intraoperative adverse reactions were compared be-tween the two groups.Results There was no significant difference in surgical condition between the two groups(P＞0.05).At T1,T2 and T3,heart rate,MAP,respiration,VAS score,OAA/S score and serum ALD,Cor and NE in the research group were lower than those in the control group(P＜0.05,P＜0.01).At 3,12,24 and 48 h after operation,the BCS of the research group was higher than that of the control group(P＜0.01).There was no significant difference in the total inci-dence of adverse reactions between the research group and the control group(13/51,25.49%vs.18/50,36.00%;P＞0.05).Conclusion The subanesthetic dose Esketamine combined with Dexmedetomidine can alleviate stress response,sta-bilize respiratory circulation,and have good sedative and analgesic effect in OVCF patients undergoing vertebroplasty,with good safety.
维普
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