摘要
目的 对比分析右美托咪定与氟比洛芬酯在老年全膝关节置换术患者超前镇痛中的应用效果.方法 选取2020 年12 月至2022 年4 月项城市中医院收治的140 例拟行全膝关节置换术治疗的老年患者作为研究对象,按照不同超前镇痛方法将其分为右美托咪定组(70 例)和氟比洛芬酯组(70 例),右美托咪定组患者麻醉诱导前采用 1.5 μg/kg右美托咪定进行超前镇痛,氟比洛芬酯组患者麻醉诱导前采用 1.0 mg/kg氟比洛芬酯进行超前镇痛,对比观察两组患者血流动力学指标以及疼痛、镇静评分和不良反应发生情况.结果 T1-6时,右美托咪定组患者心率(HR)、平均动脉压(MAP)均明显低于氟比洛芬酯组(HR:t=8.034、6.937、2.673、3.003、8.398、9.002,P＜0.001、P＜0.001、P=0.008、P=0.003、P＜0.001、P＜0.001;MAP:t=8.593、8.187、8.178、12.376、9.141、11.299,P均＜0.001).除术后 2h右美托咪定组患者视觉模拟评分法(VAS)评分与氟比洛芬酯组无明显差异(t=0.271,P=0.787)外,术后 4、8、16、32 h右美托咪定组患者VAS评分均明显低于氟比洛芬酯组(t=4.894、4.950、6.081、4.932,P均＜0.001).术后 2、4、8、16、32 h,右美托咪定组患者Ramsay镇静评分均明显高于氟比洛芬酯组(t=3.636、5.966、4.104、6.246、6.999,P均＜0.001).右美托咪定组患者不良反应发生率为 4.29%,与氟比洛芬酯组患者的不良反应发生率 7.14%无明显差异(χ2=0.133,P=0.716).结论 老年全膝关节置换术中应用右美托咪定进行超前镇痛,能够有效维持血流动力学稳定性,镇痛、镇静效果好,且无明显不良反应发生,安全性较高.
Abstract
Objective To compare the clinical efficacy of dexmedetomidine and flurbiprofen axetil for preemptive analgesia in elderly patients undergoing total knee arthroplasty.Methods 140 elderly patients admitted to Xiangcheng Hospital of Traditional Chinese Medicine from December 2020 to April 2022 for total knee arthroplasty were enrolled as research subjects and divided into the dexmedetomidine group(n=70)and the flurbiprofen axetil group(n=70)according to the different preemptive analgesia methods they received.Patients in the dexmedetomidine group were given 1.5 μg/kg dexmedetomidine for preemptive analgesia before anesthesia induction,whereas patients in the flurbiprofen axetil group were given 1.0 mg/kg flurbiprofen axetil for preemptive analgesia before anesthesia induction.Hemodynamic parameters,pain and sedation scores,and occurrence of adverse reactions of patients were compared between the two groups.Results At the six timepoints from T1 to T6,the heart rate(HR)and mean arterial pressure(MAP)of patients in the dexmedetomidine group were all significantly lower than those in the flurbiprofen axetil group(HR:t=8.034,6.937,2.673,3.003,8.398 and 9.002,P＜0.001,P＜0.001,P=0.008,P=0.003,P＜0.001,P＜0.001;MAP:t=8.593,8.187,8.178,12.376,9.141 and 11.299,all P＜0.001).Except the visual analogue scale(VAS)score at the timepoint of 2 hours after operation which showed no significant difference between the two groups(t=0.271,P=0.787),the VAS scores respectively at 4,8,16 and 32 hours after operation were all significantly lower in the dexmedetomidine group than those in the flurbiprofen axetil group(t=4.894,4.950,6.081 and 4.932,all P＜0.001).Respectively at 2,4,8,16 and 32 hours after opera-tion,the Ramsay sedation scores were all significantly higher in the dexmedetomidine group compared with the flurbiprofen axetil group(t=3.636,5.966,4.104,6.246 and 6.999,all P＜0.001).The incidence of patients'adverse reactions in the dexmedetomidine group was 4.29%,showing no statistically significant difference compared with the corresponding 7.14%in the flurbiprofen axetil group(χ2=0.133,P=0.716).Conclusion Preemptive analgesia with dexmedetomidine in elderly patients undergoing total knee arthroplasty can effectively maintain patients'hemodynamic stability and realize good analgesic and sedative effects without resulting in significant adverse reactions,and thus is safe to apply in clinical practice.
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