目的 探究右美托咪定联合罗哌卡因椎管内麻醉在老年下肢骨折手术中的应用效果及对患者认知功能的影响.方法 选取2021年1月-2023年8月我院收治的60例老年下肢骨折患者,依据随机数字表法分为对照组(30例)与研究组(30例),对照组采用罗哌卡因麻醉,研究组给予右美托咪定联合罗哌卡因椎管内麻醉.比较两组术前、术后24 h血流动力学指标[心率(HR)、脉搏血氧饱和度(SpO2)、平均动脉压(MAP)、呼吸频率]、应激状态指标[甲肾上腺素(NE)、肾上腺素(E)和皮质醇水平(Cor)]、疼痛介质水平[内啡肽(β-EP)、P物质(SP)、缓激肽(BK)、前列腺素E2(PGE2)、一氧化氮(NO)]及认知功能.结果 研究组术后24 h HR、SpO2、MAP水平及呼吸频率均低于对照组(P<0.05);两组术后24 h NE、E、Cor、β-EP、SP、BK、PGE2水平高于术前,研究组NE、E、Cor、β-EP、SP、BK、PGE2水平低于对照组(P<0.05);两组术后24 h NO水平低于术前,研究组NO水平高于对照组(P<0.05);术后6、12、24 h,研究组认知功能评分高于对照组(P<0.05).结论 右美托咪定联合罗哌卡因椎管内麻醉用于老年下肢骨折手术中效果良好,可稳定患者血流动力学水平,降低应激反应,改善患者认知功能,值得临床应用.
Anesthetic Effect of Dexmedetomidine Combined with Ropivacaine Intraspinal Anesthesia in Elderly Patients with Lower Limb Fracture and its Effect on Cognitive Function
Objective To explore the application effect of dexmedetomidine combined with ropivacaine spinal anesthesia in elderly lower limb fracture surgery and its effect on cognitive function.Methods A total of 60 elderly patients with lower limb fractures admitted to our hospital from January 2021 to August 2023 were selected and divided into control group (30 patients) and study group (30patients) according to the random number table method. The control group was anesthetized with ropivacaine,and the study group was given dexmedetomidine combined with ropivacaine for spinal anesthesia. The hemodynamic indexes[heart rate (HR),pulse oxygen saturation (SpO2),mean arterial pressure (MAP),respiratory rate],stress state indexes[norepinephrine (NE),epinephrine (E) and cortisol levels (Cor)],pain medium levels[endorphin (β-EP),substance P (SP),bradykinin (BK),prostaglandin E2 (PGE2),nitric oxide (NO)]and cognitive function were compared between the two groups before and 24 h after operation. Results The levels of HR,SpO2,MAP and respiratory rate at 24 h after operation in the study group were lower than those in the control group (P<0.05). The levels of NE,E,Cor,β-EP,SP,BK and PGE2 in the two groups at 24 h after operation were higher than those before operation,and the levels of NE,E,Cor,β-EP,SP,BK and PGE2 in the study group were lower than those in the control group (P<0.05). The level of NO at 24 h after operation in the two groups was lower than that before operation,and the level of NO in the study group was higher than that in the control group (P<0.05). At 6,12 and 24 h after operation,the cognitive function score of the study group was higher than that of the control group (P<0.05).Conclusion Dexmedetomidine combined with ropivacaine intraspinal anesthesia has a good effect in elderly patients with lower limb fracture surgery,which can stabilize the hemodynamic level of patients,reduce stress response,and improve the cognitive function of patients. It is worthy of clinical application.
Lower limb fracture in the elderlyDexmedetomidineRopivacaineIntraspinal anesthesiaCognitive function
万方数据
维普
