右美托咪定在老年上肢骨折患者臂丛神经阻滞中的应用观察

Observations on the use of dexmedetomidine in brachial plexus nerve block in elderly patients with upper limb fractures

摘要:

目的 探讨右美托咪定在老年上肢骨折患者臂丛神经阻滞中的应用价值。方法 选取2020年5月—2022年10月安徽医科大学附属宿州医院80例老年上肢骨折手术患者，随机分为对照组和观察组，各40例。对照组行臂丛神经阻滞+芬太尼，观察组行臂丛神经阻滞+芬太尼+右美托咪定。比较两组神经阻滞前（T₁）、神经阻滞即刻（T₂）、麻醉后10 min（T₃）、手术开始后5 min（T₄）、手术开始后30 min（T₅）、术毕（T₆）的血流动力学［平均动脉压（MAP）、心率（HR）］，Ramsay镇静评分，T₁、T₅、T₆时应激激素水平［去甲肾上腺素（NE）、肾上腺素（E）、皮质醇（Cor）］，麻醉前、术后24 h、术后72 h前列腺素（PG）E2、神经生长因子（NGF）水平，麻醉前及术后1、3、7 d认知功能。结果 观察组与对照组T₁～T₆时MAP、HR比较，结果 ①不同时间点的MAP、HR比较，差异有统计学意义（F =6.582和8.632，P =0.047和0.000）；②两组的MAP、HR比较，差异有统计学意义（F =8.931和12.023，均P =0.000）；③两组MAP、HR评分变化趋势比较，差异有统计学意义（F =7.269和9.438，均P =0.000）。观察组与对照组T₁～T₆时刻Ramsay镇静评分比较，结果 ①不同时间点的Ramsay镇静评分比较，差异有统计学意义（F =11.023，P =0.000）；②两组的Ramsay镇静评分比较，差异有统计学意义（F =8.632，P =0.000）；③两组Ramsay镇静评分变化趋势比较，差异有统计学意义（F =9.225，P =0.000）。观察组与对照组T₁、T₅、T₆时NE、E及Cor水平比较，结果 ①不同时间点的NE、E及Cor水平比较，差异有统计学意义（F =7.125、37.523和22.057，均P =0.000）；②两组的NE、E及Cor水平比较，差异有统计学意义（F =26.354、23.727和18.636，均P =0.000）；③两组NE、E及Cor水平变化趋势比较，差异有统计学意义（F =18.635、28.079和20.547，均P =0.000）。观察组与对照组麻醉前、术后24 h、72 h血清PGE2、NGF比较，结果 ①不同时间点的血清PGE2、NGF水平比较，差异有统计学意义（F =21.252和39.524，均P =0.000）；②两组的血清PGE2、NGF比较，差异有统计学意义（F =29.635和25.419，均P =0.000）；③两组血清PGE2、NGF变化趋势比较，差异有统计学意义（F =25.736和28.447，均P =0.000）。观察组与对照组麻醉前、术后1、3、7 d认知功能评分比较，结果 ①不同时间点的认知功能评分比较，差异有统计学意义（F =8.225，P =0.000）；②两组的认知功能评分比较，差异有统计学意义（F =6.872，P =0.000）；③两组认知功能评分变化趋势比较，差异有统计学意义（F =8.029，P =0.000）。结论 右美托咪定在老年上肢骨折臂丛神经阻滞中镇静效果好，可有效减轻患者术中应激反应，维持血流动力学稳定，减轻术后疼痛感，促进术后认知功能恢复。

Abstract:

Objective To explore the application value of dexmedetomidine in brachial plexus nerve block for elderly patients with upper limb fractures.Methods A total of 80 elderly patients with upper limb fractures who underwent surgery in our hospital from May 2020 to October 2022 were randomly divided into two groups, with 40 patients in each group. The control group received brachial plexus block plus fentanyl, while the observation group received brachial plexus block plus fentanyl plus dexmedetomidine. The hemodynamic [Mean arterial pressure (MAP), heart rate (HR)] and Ramsay sedation scores before nerve block (T₁), immediately after nerve block (T₂), 10 min after anesthesia (T₃), 5 min after the start of surgery (T₄), 30 min after the start of surgery (T₅), and at the end of the surgery (T₆), the levels of stress hormones [Norepinephrine (NE), Epinephrine (E), Cortisol (Cor)] at T₁, T₅, and T₆, and the levels of prostaglandin E2 (PGE2) and nerve growth factor (NGF) before anesthesia, at 24 h, and at 72 h after the operation, as well as cognitive function before anesthesia and at 1 d, 3 d, and 7 d postoperatively were compared in the two groups.Results The comparison of MAP and HR between the observation group and the control group at T₁-T₆ showed the following results: (1) There were significant differences in MAP and HR at different time points (F =6.582 and 8.632, P =0.047 and 0.000); (2) There were significant differences in MAP and HR between the observation group and the control group (F =8.931 and 12.023, all P =0.000); (3) The differences in the change trend of MAP and HR scores between the two groups were statistically significant (F =7.269, 9.438, all P =0.000). The comparison of Ramsay sedation scores between the observation group and the control group at time points T₁-T₆ showed the following results: (1) There was a significant difference in Ramsay sedation scores at different time points (F =11.023, P =0.000); (2) There was a significant difference in Ramsay sedation scores between the observation group and the control group (F =8.632, P =0.000); (3) There was a significant difference in the change trend of Ramsay sedation scores between the two groups (F =9.225, P =0.000). The comparison of NE, E, and Cor levels at T₁, T₅, and T₆ between the observation group and the control group revealed the following results: (1) The comparison of NE, E, and Cor levels at different times showed significant differences (F =7.125, 37.523 and 22.057, all P =0.000); (2) The comparison of NE, E, and Cor levels between the observation group and the control group showed significant differences (F =26.354, 23.727 and 18.636, all P =0.000); (3) The comparison of the change trends of NE, E, and Cor levels between the two groups showed significant differences (F =18.635, 28.079 and 20.547, all P =0.000). The comparison of serum PGE2 and NGF levels between the observation group and the control group before anesthesia, 24 hours and 72 hours after surgery showed the following results: (1)There was a significant difference in the levels of serum PGE2 and NGF at different times (F =21.252 and 39.524, all P =0.000);(2) There was a significant difference in the levels of serum PGE2 and NGF between the observation group and the control group (F =29.635 and 25.419, all P =0.000); (3)The comparison of the change trends of serum PGE2 and NGF between the two groups showed significant differences (F =25.736 and 28.447, all P =0.000). The comparison of cognitive function scores between the observation group and the control group before anesthesia, and on postoperative day 1, 3, and 7 revealed the following results: (1) There was a significant difference in cognitive function scores at different times (F =8.225, P =0.000); (2) There was a significant difference in cognitive function scores between the observation group and the control group (F =6.872, P =0.000); (3) There was a significant difference in the change trend of serum cognitive function scores between the two groups (F =8.029, P =0.000).Conclusion Dexmedetomidine has good sedative effect in brachial plexus nerve block for elderly patients with upper limb fractures, which can effectively reduce the stress response of patients during surgery, maintain hemodynamic stability, alleviate postoperative pain, and promote postoperative cognitive function recovery.