| 张碧潭,王钰钤.不同剂量右美托咪定在胸腰椎骨折手术患者辅助麻醉中的应用效果分析[J].中国烧伤创疡杂志,2024,(2):129~133. |
| DOI： |
| 中文关键词: 胸腰椎骨折 右美托咪定 剂量 认知功能 应激反应 血流动力学 |
| 英文关键词:Thoracolumbar fracture Dexmedetomidine Dose Cognitive function Stress response Hemodynamics |
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| 中文摘要: |
| 【摘要】 目的 探讨不同剂量右美托咪定对胸腰椎骨折手术患者血流动力学、应激反应及认知功能的影响。方法 选取2019 年3 月至2022 年3 月南阳市第一人民医院收治的90 例行手术治疗的胸腰椎骨折患者作为研究对象, 按照不同麻醉方法将其分为高剂量组 (45 例) 和低剂量组 (45 例)。高剂量组患者麻醉诱导前及术中分别应用0.8 μg / kg及 0.8 μg·kg-1·h-1右美托咪定, 低剂量组患者麻醉诱导前及术中分别应用0.5 μg / kg 及 0.5 μg·kg-1·h-1右美托咪定, 对比观察两组患者术中出血量、手术结束至拔管时间、麻醉时间、自主呼吸恢复时间、苏醒时间等手术相关指标, 心率、血氧饱和度、平均动脉压等血流动力学指标, 血清肾上腺素、去甲肾上腺素、皮质醇水平等应激反应指标, 认知功能及不良反应。 结果 高剂量组患者手术结束至拔管时间、自主呼吸恢复时间、苏醒时间均明显短于低剂量组 (t = 3.626、7.084、8.044, P 均<0.001),而术中出血量、麻醉时间与低剂量组无明显差异(t = 0.586、0.486, P= 0.559、0.628); 除 T2 时高剂量组患者心率、平均动脉压明显低于低剂量组 ( t = 2.218、4.375, P= 0.029、P<0.001) 外, 其余时间点两组患者心率、血氧饱和度、平均动脉压均无明显差异 (心率:t = 0.134、0.629、0.709, P= 0.894、0.531、0.480; 血氧饱和度: t = 0.164、1.255、0.462、1.791, P = 0.871、0.213、0.645、0.077; 平均动脉压: t = 0.272、0.614、0.841, P = 0.787、0.541、0.403); 术后 1 d, 高剂量组患者肾上腺素、去甲肾上腺素、皮质醇水平均明显低于低剂量组 ( t = 4.768、10.879、4.311, P 均<0.001); 术后 1 d, 高剂量组患者简易精神状态检查量表评分为 (25.81±1.42) 分, 与低剂量组患者简易精神状态检查量表评分(25.44±1.31)分无明显差异 (t = 1.285, P= 0.202); 高剂量组患者术后不良反应发生率为 13.33%,明显低于低剂量组患者的术后不良反应发生率35.56% ( χ2 = 6.016, P = 0.014)。结论 麻醉诱导前缓慢静脉泵注0.8 μg /kg右美托咪定、术中持续静脉泵注0.8 μg·kg-1·h-1右美托咪定更有助于胸腰椎骨折手术患者术后苏醒及自主呼吸恢复, 维持血流动力学稳定性, 降低手术创伤引发的应激反应程度及不良反应发生率。 |
| 英文摘要: |
| 【Abstract】 Objective To study the clinical efficacy of different doses of dexmedetomidine on hemodynamics, stress response and cognitive function of patients receiving surgery for thoracolumbar fracture. Methods 90 patients with thoracolumbar fracture, admitted into Nanyang First People’s Hospital between March 2019 and March 2022 for surgery treatment, were enrolled as research subjects and divided into high dose group (n = 45) and low dose group (n = 45) based on different anesthesia methods they received. Patients in the high dose group were given 0.8 μg / kg and 0.8 μg·kg-1·h-1 dexmedetomidine before anesthesia induction and during the operation respectively, while patients in the low dose group were given corresponding 0.5 μg / kg and 0.5 μg·kg-1 ·h-1 dexmedetomidine respectively. The surgery?related indexes including intraoperative blood loss, the time from the end of operation to extubation, anesthesia time, spontaneous breathing recovery time and the recovery time, hemodynamic parameters such as heart rate, blood oxygen saturation and mean arterial pressure, stress response indicators such as serum epinephrine, norepinephrine, cortisol levels, cognitive function and adverse reactions were compared between the two groups. Results The time from the end of operation to extubation, spontaneous breathing recovery time and the recovery time of patients in the high dose group were significantly shorter than those in the low dose group (t = 3.626, 7.084 and 8.044, all P<0.001), while there was no significant difference in intraoperative blood loss and anesthesia time between the two groups (t = 0.586 and 0.486, P = 0.559 and 0.628). Except that the heart rate and mean arterial pressure of patients in the high dose group were significantly lower than those in the low dose group at T2 (t = 2.218 and 4.375, P= 0.029, P<0.001), there were no significant differences in heart rate, blood oxygen saturation, and mean arterial pressure between the two groups at the other time points ( heart rate: t = 0.134, 0.629 and 0.709, P= 0.894, 0.531 and 0.480; blood oxygen saturation: t = 0.164, 1.255, 0.462 and 1.791, P = 0.871, 0.213, 0.645 and 0.077; mean arterial pressure: t = 0.272, 0.614 and 0.841, P = 0.787, 0.541 and 0.403). One day after operation, the levels of epinephrine, norepinephrine and cortisol of patients in the high dose group were significantly lower than those in the low dose group (t = 4.768, 10.879 and 4.311, all P<0.001). One day after operation, the minimental state examination score of patients in the high dose group was (25.81±1.42) points, showing no significant difference as compared with (25.44±1.31) points in the low dose group (t = 1.285, P= 0.202). The incidence of postoperative adverse reactions of patients in the high dose group was 13.33%, being much lower than 35.56% in the low dose group ( χ2 =6.016, P= 0.014). Conclusion Slow intravenous pumping of 0.8 μg / kg dexmedetomidine before anesthesia induction and continuous intravenous pumping of 0.8 μg·kg-1·h-1 dexmedetomidine during the operation are more conducive to the postoperative recovery and spontaneous breathing recovery of patients receiving surgery for thoracolumbar fracture, maintaining hemodynamic stability, and reducing the degree of stress response caused by surgical trauma and the incidence of adverse reactions. |
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