右美托咪定两种给药时机对全麻老年髋部骨折病人术中缺血再灌注损伤、麻醉苏醒的影响

李井华; 孟志艳

右美托咪定两种给药时机对全麻老年髋部骨折病人术中缺血再灌注损伤、麻醉苏醒的影响

Effect of two timing of dexmedetomidine administration on intraoperative ischemia-reperfusion injury and anesthetic awakening in elderly hip fracture patients under general anesthesia

摘要

摘要:
目的： 探讨右美托咪定两种给药时机对全麻老年髋部骨折术阿片类和镇静剂用量、缺血再灌注损伤、麻醉苏醒的影响。
方法： 选取580例老年髋部骨折病人，按照随机数字表法分组，各290例。2组均行全麻，A组于麻醉诱导前输注右美托咪定，B组于麻醉诱导后输注右美托咪定。比较2组不同时间点血流动力学平均动脉压（MAP）、心率（HR）、缺血再灌注损伤指标超氧化物歧化酶（SOD）、丙二醛（MDA）、髓过氧化物酶（MPO）、肿瘤坏死细胞因子-α（TNF-α）、苏醒时间、术后疼痛（VAS）评分、Ramsay镇静评分、阿片类和镇静剂用量及不良反应率。
结果： 2组T₁～T₅时HR、MAP均低于T₀时（P ＜ 0.05），但组间T₁～T₅时HR差异无统计学意义（P ＞ 0.05）；2组T₀、T₁时MAP差异无统计学意义（P ＞ 0.05）；A组T₂～T₅时MAP明显高于B组（P ＜ 0.01）；2组手术开始30 min后、手术结束时血清SOD水平低于术前（P ＜ 0.05），A组明显高于B组（P ＜ 0.01），MDA、MPO、TNF-α水平高于术前（P ＜ 0.05），A组明显低于B组（P ＜ 0.01）；A组苏醒时间明显短于B组（P ＜ 0.01）；2组术后6 h、12 h、24 h、48 h VAS评分、Ramsay镇静评分呈逐渐下降趋势（P ＜ 0.05），A组明显低于B组（P ＜ 0.01）；A组芬太尼、丙泊酚用量低于B组（P ＜ 0.01）；2组不良反应发生率差异无统计学意义（P ＞ 0.05）。
结论： 与麻醉诱导后相比，麻醉诱导前输注右美托咪定应用于全麻老年髋部骨折术能稳定血流动力学，改善镇静、镇静效果，还能减轻缺血再灌注损伤，提高麻醉苏醒质量，减少镇痛镇静药物用量，且安全性良好。

Abstract:
Objective To investigate the effects of two timing of dexmedetomidine administration on opioid and sedation dosage, ischemia-reperfusion injury, and anesthesia awakening in geriatric hip fracture surgery under general anesthesia.
Methods Five hundred and eighty elderly patients with hip fracture were divided into A and B groups according to the random number table method (290 cases each group). General anesthesia was administered in both groups, and Group A was given dexmedetomidine before anesthesia induction, group B was given dexmedetomidine after anesthesia induction. The hemodynamicsmean arterial pressure (MAP) and heart rate (HR), ischemia-reperfusion injury indexessuperoxide dismutase (SOD), malondialdehyde (MDA), myeloperoxidase (MPO) and tumor necrosis cytokines α(TNF-α), recovery time, postoperative pain (VAS) score and Ramsay sedation score, opioid and sedative dosage and adverse reaction rate were compared between two groups at different time points.
Results The HR and MAP in two groups at T1-T5 were lower than those at T0 (P ＜ 0.05), but there was no statistical significance in the HR at T1 to T5 between two groups (P ＞ 0.05). There was no statistical significance in the MAP between two groups at T0 and T1 (P ＞ 0.05). The MAP in the A group at T2 to T5 was significantly higher than that in B group (P ＜ 0.01). After 30min of operation and at the end of operation, the serum levels of SOD in two groups were lower than that before operation (P ＜ 0.05), and which in the A group was significantly higher than that in B group (P ＜ 0.01); The levels of MDA, MPO and TNF-α levels were significantly higher than those before surgery (P ＜ 0.05), and those in A group were significantly lower than those in B group (P ＜ 0.01). The recovery time of A group was significantly shorter than that of B group (P ＜ 0.01). After 6 h, 12 h, 24 h and 48 h of surgery, the VAS scores and Ramsay sedation scores in two groups gradually decreased (P ＜ 0.05), and which in A group was significantly lower than that in B group (P ＜ 0.01). The dosage of fentanyl and propofol in A group were lower than those in B group (P ＜ 0.01); There was no statistical significance in the incidence of adverse reactions between two groups (P ＞ 0.05).
Conclusions Compared with after anesthesia induction, the dexmedetomidine infusion before anesthesia induction can stabilize hemodynamics, improve sedation and sedation effect, reduce ischemia reperfusion injury, improve anesthesia recovery quality, reduce the dosage of analgesic and sedative drugs, and has good safety.

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