首页|右美托咪定辅助腰丛-坐骨神经阻滞麻醉对膝关节置换术患者应激反应及认知功能的影响

右美托咪定辅助腰丛-坐骨神经阻滞麻醉对膝关节置换术患者应激反应及认知功能的影响

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目的 探讨右美托咪定辅助腰丛-坐骨神经阻滞麻醉对膝关节置换术患者应激反应及认知功能的影响.方法 选取我院2020年3月至2022年3月收治的100 例行膝关节置换术治疗患者,采用随机数字表法将其分为观察组(n=50)和对照组(n=50).两组均行腰丛-坐骨神经阻滞麻醉,对照组采用咪达唑仑辅助麻醉,观察组采用右美托咪定辅助麻醉.比较两组入室前(T0)、神经阻滞完成后即刻(T1)、手术开始后15 min(T2)、术毕即刻(T3)的心率(HR)、平均动脉压(MAP)及疼痛视觉模拟量表(VAS)评分;比较两组术前及术后 4h的促肾上腺皮质激素(ACTH)、一氧化氮(NO)、去甲肾上腺素(NE)水平及简易智力状态检查量表(MMSE)评分.结果 T0,两组的HR、MAP比较,差异无统计学意义(P>0.05);T1、T2、T3,观察组的HR、MAP高于对照组,差异具有统计学意义(P<0.05).T1、T2、T3,观察组的VAS评分低于对照组,差异具有统计学意义(P<0.05).术前,两组的ACTH、NO及NE水平比较,差异无统计学意义(P>0.05);术后4h,两组的ACTH、NO及NE水平均明显升高,但观察组低于对照组(P<0.05).术后 4h,两组的MMSE评分均明显降低,但观察组高于对照组(P<0.05).结论 右美托咪定辅助腰丛-坐骨神经阻滞麻醉可减轻膝关节置换术患者应激反应及降低认知功能障碍发生,值得推广.
Effects of dexmedetomidine-assisted lumbar plexus-sciatic nerve block anesthesia on stress response and cognitive function in patients undergoing knee arthroplasty
Objective To investigate the effects of dexmedetomidine-assisted lumbar plexus-sciatic nerve block anesthesia on stress response and cognitive function in patients undergoing knee arthroplasty.Methods A total of 100 patients undergoing knee arthroplasty admitted in our hospital from March 2020 to March 2022 were selected and divided into observation group(n=50)and control group(n=50)by random number table method.Both groups underwent lumbar plexus-sciatic nerve block anesthesia.The control group was anesthetized with midazolam,and the observation group was anesthetized with dexmedetomidine.The heart rate(HR),mean arterial pressure(MAP)and visual analogue scale(VAS)score were compared between the two groups before entering the operating room(T0),immediately after the completion of nerve block(T1),15 min after the start of surgery(T2),immediately after surgery(T3);the levels of adrenocorticotrophic hormone(ACTH),nitric oxide(NO),norepinephrine(NE)and Mini-Mental State Examination(MMSE)score were compared between the two groups before and 4 h after operation.Results At T0,there were no significant differences in HR and MAP between the two groups(P>0.05);at T1,T2 and T3,the HR and MAP of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).At T1,T2 and T3,the VAS score of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).Before operation,there were no significant differences in ACTH,NO and NE levels between the two groups(P>0.05);at 4 h after operation,the levels of ACTH,NO and NE in the two groups increased significantly,but those in the observation group were lower than the control group(P<0.05).At 4 h after operation,the MMSE score of the two groups decreased significantly,but that in the observation group was higher than the control group(P<0.05).Conclusion Dexmedetomidine-assisted lumbar plexus-sciatic nerve block anesthesia can reduce the stress response and decrease the occurrence of cognitive dysfunction in patients undergoing knee arthroplasty,which is worthy of promotion.

dexmedetomidinelumbar plexus-sciatic nerve block anesthesiaknee arthroplastystress responsecognitive function

卫宇龙、郭争社、王德智

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西安市红会医院,陕西 西安,710000

右美托咪定 腰丛-坐骨神经阻滞麻醉 膝关节置换术 应激反应 认知功能

陕西省重点研发计划

2019SF-049

2024

临床医学研究与实践

临床医学研究与实践

ISSN:
年,卷(期):2024.9(17)