| 冯 炫,王 洁,刘 旭,李文瑶,杨 烨,陶国才,陈 澜.不同剂量右美托咪定联合超声引导下多点髂筋膜间隙阻滞在老年全髋关节置换术中的应用效果分析[J].,2023,(15):2868-2872 |
| 不同剂量右美托咪定联合超声引导下多点髂筋膜间隙阻滞在老年全髋关节置换术中的应用效果分析 |
| Application Effect Analysis of Different Doses of Dexmedetomidine Combined with Ultrasound-guided Multipoint Iliac Fascia Space Block in Elderly Total Hip Arthroplasty |
| 投稿时间：2022-12-12 修订日期：2022-12-31 |
| DOI：10.13241/j.cnki.pmb.2023.15.013 |
| 中文关键词: 不同剂量 右美托咪定 超声引导下多点髂筋膜间隙阻滞 老年 全髋关节置换术 应用效果 |
| 英文关键词: Different doses Dextrmetomidine Ultrasound-guided multipoint iliac fascia space block Elderly Total hip arthroplasty Application effect |
| 基金项目:国家自然科学基金项目（81171034） |
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| 中文摘要: |
| 摘要 目的：探讨超声引导下多点髂筋膜间隙阻滞联合不同剂量右美托咪定在老年全髋关节置换术（THA）中的应用效果。方法：选取2019年11月-2022年12月北京积水潭医院贵州医院择期行THA的老年患者120例，按照随机数字表法分为A组（n=40）、B组（n=40）、C组（n=40），三组均接受超声引导下多点髂筋膜间隙阻滞治疗，在此基础上，A组、B组、C组分别给予0.5 μg/kg、1.0 μg/kg、1.5 μg/kg右美托咪定注射液。对比三组临床指标、血流动力学指标、应激反应指标、脑神经损伤情况，观察三组围术期间不良反应发生情况。结果：B组、C组的阻滞消退时间、拔管时间长于A组，首次下床时间短于A组（P<0.05）。B组、C组的阻滞消退时间、拔管时间、首次下床时间对比无差异（P>0.05）。三组麻醉诱导后即刻（T1）~手术结束时（T3）时间点心率（HR）、平均动脉压（MAP）升高后降低（P<0.05）。B组、C组的T1~T3时间点HR、MAP均低于A组，且B组低于C组（P<0.05）。三组T3时间点皮质醇（Cor）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）升高（P<0.05）。B组、C组的T3时间点Cor、IL-6、TNF-α均低于A组，且B组低于C组（P<0.05）。B组、C组的T3时间点中枢神经特异性蛋白（S100β）均低于A组，且B组低于C组（P<0.05）。B组、C组的T3时间点脑源性神经生长因子（BDNF）均高于A组，且B组高于C组（P<0.05）。三组不良反应发生率组间对比无差异（P>0.05）。结论：超声引导下多点髂筋膜间隙阻滞联合1.0 μg/kg右美托咪定在THA中具有更好的麻醉效果，可缩短首次下床时间，减轻机体应激反应、血流动力学波动以及脑部神经损伤。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the application effect of ultrasound-guided multipoint iliac fascia space block combined with different doses of dexmedetomidine in elderly total hip arthroplasty (THA). Methods: 120 elderly patients who received THA in Beijing Jishuitan Hospital Guizhou Hospital from November 2019 to December 2022 were selected, and they were divided into group A (n=40), group B (n=40) and group C (n=40) according to random number table method. All three groups received ultrasound-guided multipoint iliac fascia space block treatment, on this basis, group A, group B and group C were given 0.5 μg/kg, 1.0 μg/kg and 1.5 μg/kg dexmedetomidine injection, respectively. The clinical indexes, hemodynamic indexes, stress response indexes and cranial nerve injury in the three groups were compared, and the occurrence of perioperative adverse reactions in the three groups were observed. Results: The blockage resolution time and extubation time in the group B and group C were longer than those in the group A, and the first time out of bed was shorter than that in the group A (P<0.05). There were no differences between group B and group C in blockage resolution time, extubation time and first getting out of bed time (P>0.05). Heart rate (HR) and mean arterial pressure (MAP) increased and decreased from immediately after anesthesia induction (T1) to the end of surgery (T3) time points (P<0.05). HR and MAP at T1-T3 time points in the group B and group C were lower than those in the group A, and the group B was lower than the group C (P<0.05). Cortisol (Cor), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) increased in three groups at T3 time point (P<0.05). The Cor, IL-6 and TNF-α at T3 time point in the group B and group C were lower than those in the group A, and the group B was lower than the group C (P<0.05). The T3 time-point central nervous system specific protein (S100β) in the group B and group C was lower than that in the group A, and the group B was lower than the group C (P<0.05). The T3 time point brain-derived nerve growth factor (BDNF) in the group B and group C was higher than the group A, and group B was higher than the group C (P<0.05). There was no difference in the incidence of adverse reactions in the three groups (P>0.05). Conclusion: Ultrasound-guided multipoint iliac fascia space block combined with 1.0 μg/kg dexmedetomidine has a better anesthetic effect in THA, which can shorten the first time out of bed, reduce the stress response, hemodynamic fluctuations and cranial nerve injury. |
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