蛛网膜下腔阻滞麻醉联合右美托咪定对股骨颈骨折手术患者的影响

Effects of combined spinal anesthesia and dexmedetomidine on patients undergoing femoral neck fracture surgery

摘要:

目的 探讨蛛网膜下腔阻滞麻醉联合右美托咪定对股骨颈骨折手术患者的影响。方法 选取2020年8月—2023年8月于西安市中医医院行股骨颈骨折手术的80例股骨颈骨折患者，采用摸球法分组，奇数为对照组，偶数为观察组，每组40例。对照组予以蛛网膜下腔阻滞麻醉+生理盐水；观察组予以蛛网膜下腔阻滞麻醉+右美托咪定。比较两组不同时点的血流动力学［麻醉前（T₀）、术中1 min（T₁）、术后1 min（T₂）的心率（HR）、平均动脉压（MAP）］，术后2、4、8、12 h的视觉模拟评分法（VAS）和Ramsay镇静评分（RSS），术前、术后的应激反应［肾上腺素（AD）、皮质醇（Cor）］水平，以及两组不良反应发生情况。结果 两组T₀、T₁、T₂时的HR、MAP水平比较，结果 ①不同时间点HR、MAP水平比较，差异有统计学意义（P <0.05）；②观察组与对照组HR、MAP水平比较，差异有统计学意义（P <0.05），观察组HR、MAP水平较低，相对血流动力学较稳定；③两组HR、MAP水平变化趋势比较，差异有统计学意义（P <0.05）。两组术后2、4、8、12 h的静息状态下VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组VAS评分比较，差异有统计学意义（P <0.05），观察组VAS评分较低，相对镇痛效果较好；③两组VAS评分变化趋势比较，差异无统计学意义（P >0.05）。两组术后2、4、8、12 h的RSS评分比较，结果 ①不同时间点RSS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组RSS评分比较，差异有统计学意义（P <0.05），观察组RSS评分较高，相对镇静效果较好；③两组RSS评分变化趋势比较，差异无统计学意义（P >0.05）。观察组术前、术后AD、Cor水平差值低于对照组（P <0.05）；两组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 蛛网膜下腔阻滞麻醉联合右美托咪定可以有效稳定股骨颈骨折手术患者的术中及术后HR、MAP水平，降低疼痛程度，提高镇静效果，降低应激反应水平，且不增加不良反应发生率，表明其对股骨颈骨折手术患者的镇痛效果有显著提升。

Abstract:

Objective To explore the effects of combined spinal anesthesia and dexmedetomidine on patients undergoing femoral neck fracture surgery.Methods Eighty patients with femoral neck fractures who underwent surgery at Xi’an Traditional Chinese Medicine Hospital from August 2020 to August 2023 were selected and divided into a control group and an observation group (40 patients each) using odd-even randomization. The control group received spinal anesthesia with saline, while the observation group received spinal anesthesia combined with dexmedetomidine. Hemodynamics, including heart rate (HR) and mean arterial pressure (MAP) at three time points [pre-anesthesia (T₀), 1 min intraoperatively (T₁), and 1 min postoperatively (T₂)], postoperative Visual Analog Scale (VAS) scores and Ramsay Sedation Scores (RSS) at 2, 4, 8, and 12 hours, levels of stress response indicators [adrenaline (AD) and cortisol (Cor)], and incidence of adverse reactions were compared between the two groups.Results Hemodynamics: Repeated measures ANOVA revealed significant differences in HR and MAP levels at different time points (P < 0.05). HR and MAP were lower and more stable in the observation group compared to the control group (P < 0.05), with significant differences in trends between the two groups (P < 0.05). Repeated measures ANOVA showed significant differences in VAS scores at different time points (P < 0.05). The observation group had lower VAS scores than the control group (P < 0.05), indicating better pain control. No significant difference in the trend of VAS score changes was observed between the two groups (P > 0.05). Repeated measures ANOVA showed significant differences in RSS scores at different time points (P < 0.05). The observation group had higher RSS scores than the control group (P < 0.05), indicating better sedation effects. No significant difference in the trend of RSS score changes was observed between the groups (P > 0.05). The difference in AD and Cor levels pre- and postoperatively was lower in the observation group than in the control group (P < 0.05). The total incidence of adverse reactions showed no significant difference between the two groups (P > 0.05).Conclusion Combined spinal anesthesia and dexmedetomidine effectively stabilize intraoperative and postoperative HR and MAP, reduce pain, enhance sedation, and attenuate stress responses in patients undergoing femoral neck fracture surgery, without increasing the incidence of adverse reactions. This indicates that it significantly improves pain control for such patients.