目的:探讨右美托咪定超前镇痛对老年胫腓骨骨折患者镇痛效果的影响。方法:选择2021年1月—2023年1月盘州市第二人民医院收治的82例老年胫腓骨骨折患者作为研究对象，按随机数表法将其分为对照组和观察组，各41例。观察组于切皮前15 min开始给予右美托咪定超前镇痛直至手术结束，对照组给予相同剂量的生理盐水，两组术后均采用自控静脉镇痛(PCIA)。比较两组镇静效果[Ramsay镇静评分法(RSS)]、镇痛效果[视觉模拟评分法(VAS)]、血清疼痛介质[前列腺素E2(PGE2)、P物质(SP)、缓激肽(BK)]水平、术后48 h PCIA用药量、PCIA按压次数及不良反应。结果:用药前(T1)、用药30 min(T4)，两组RSS评分比较，差异无统计学意义(P>0。05);用药10 min(T2)、用药20 min(T3)、用药30 min(T4)，两组RSS评分高于T1，但观察组仅T2、T3 RSS评分高于对照组，差异有统计学意义(P<0。05)。术前，两组VAS评分比较，差异无统计学意义(P>0。05);观察组术后 12 h、24 h VAS评分高于术前，但观察组低于对照组，观察组术后 48 h VAS评分低于术前与对照组，但对照组术后 12 h、24 h、48 h VAS评分高于术前，差异有统计学意义(P<0。05)。术前，两组血清疼痛介质水平比较，差异无统计学意义(P>0。05);术后 12 h、24 h、48 h，观察组血清PGE2、SP及BK水平低于对照组，差异有统计学意义(P<0。05)。观察组术后 48 h PCIA用药量及PCIA按压次数少于对照组，差异有统计学意义(P<0。05)。观察组不良反应发生率低于对照组，差异有统计学意义(P<0。05)。结论:老年胫腓骨骨折患者使用右美托咪定超前镇痛效果良好，可有效镇痛、镇静，减少术后PCIA用药量、PCIA按压次数及不良反应发生情况。
Effect of Dexmedetomidine Preemptive Analgesia on Analgesic Effect of Elderly Patients with Tibiofibular Fractures
Objective:To explore the effect of Dexmedetomidine preemptive analgesia on the analgesic effect of elderly patients with tibiofibular fractures.Method:A total of 82 elderly patients with tibiofibular fractures who admitted to Panzhou Second People's Hospital from January 2021 to January 2023 were selected as the research objects,they were divided into the control group and the observation group according to the random number table method,with 41 cases in each group.The observation group was given Dexmedetomidine for preemptive analgesia 15 min before skin incision until the end of operation,while the control group was given the same dose of Normal Saline,two groups were given patient-controlled intravenous analgesia(PCIA)after operation.The sedative effect[Ramsay sedation score(RSS)],analgesic effect[visual analogue scale(VAS)],serum pain mediators[prostaglandin E2(PGE2),substance P(SP),bradykinin(BK)]levels,PCIA dosage at 48 h after operation,PCIA pressing times and adverse reactions were compared between two groups.Result:Before treatment(T1)and 30 min after treatment(T4),there were no significant differences in RSS score between two groups(P>0.05);at 10 min(T2),20 min(T3)and 30 min(T4)after medication,the RSS scores of two groups were higher than those at T1,but the RSS scores only at T2 and T3 in the observation group were higher than those in the control group,and the differences were statistically significant(P<0.05).Before operation,there was no significant difference in VAS score between two groups(P>0.05);the VAS scores of the observation group at 12 h and 24 h after operation were higher than those before operation,but those of the observation group were lower than those of the control group,the VAS scores of the observation group at 48 h after operation were lower than those before operation and that of the control group,but those of the control group at 12 h,24 h and 48 h after operation were higher than those before operation,and the differences were statistically significant(P<0.05).Before operation,there were no significant differences in the levels of serum pain mediators between two groups(P>0.05);at 12 h,24 h and 48 h after operation,the levels of serum PGE2,SP and BK in the observation group were lower than the control group,the differences were statistically significant(P<0.05).The PCIA dosage and PCIA pressing times in the observation group at 48 h after operation were less than those in the control group,and the differences were statistically significant(P<0.05).The incidence of adverse reactions in the observation group was lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion:The use of Dexmedetomidine for preemptive analgesia in elderly patients with tibiofibular fractures has a good effect,which can effectively analgesia,sedation,reduce postoperative PCIA dosage,PCIA pressing times,and adverse reactions.
万方数据
维普
