右美托咪定联合不同浓度七氟烷对下肢骨折手术患者应激反应、术后恢复及脑氧代谢的影响

Effects of dexmedetomidine combined with different concentrations of sevoflurane on stress response, postoperative recovery and cerebral oxygen metabolism in patients undergoing lower extremity fracture surgery

摘要:

目的 分析右美托咪定（DEX）联合不同浓度七氟烷对下肢骨折手术患者的应用效果。方法 选取2022年4月—2024年9月在宝鸡市中医医院行下肢骨折手术的患者84例，按随机数字表法分为观察组和对照组，各42例。对照组采取DEX联合高浓度（2.5%～4.0%）七氟烷行麻醉维持，观察组采取DEX联合低浓度（1.0%～2.0%）七氟烷行麻醉维持，比较两组麻醉效果。结果 观察组与对照组T₀、T₁、T₂的心率（HR）、平均动脉压（MAP）、静脉血氧含量（CvO₂）动脉血氧含量（CaO₂）、静脉血氧含量（CvO₂）、肾上腺皮质激素（ACTH）、皮质醇、肾上腺素（AD）水平比较，结果 ①不同时间点HR、MAP、CaO₂、CvO₂、ACTH、皮质醇、AD比较，差异均有统计学意义（P <0.05）；②观察组与对照组HR、MAP比较，差异均无统计学意义（P >0.05）；观察组与对照组CaO₂、CvO₂、ACTH、皮质醇、AD比较，差异均有统计学意义（P <0.05）；③两组HR、MAP、CaO₂、CvO₂、ACTH、皮质醇、AD水平变化趋势比较，差异均有统计学意义（P <0.05）。观察组自主呼吸恢复时间和首次排气时间均短于对照组（P <0.05）。观察组术前与术后48 h的简易智力状态检查、视觉模拟评分法、蒙特利尔认知评估量表评分的差值均大于对照组（P <0.05）。观察组不良反应总发生率低于对照组（P <0.05）。结论 下肢骨折患者应用DEX联合低浓度七氟烷麻醉方案，可减小血流动力学波动、减轻认知功能损害，应激反应相对较小，且麻醉不良反应发生率较低。

Abstract:

Objective To analyze the clinical effects of dexmedetomidine (DEX) combined with different concentrations of sevoflurane in patients undergoing lower extremity fracture surgery.Methods A total of 84 patients who underwent lower extremity fracture surgery at Baoji Hospital of Traditional Chinese Medicine from April 2022 to September 2024 were selected and divided into the observation group and the control group according to the random number table method, with 42 cases in each group. The control group was given DEX combined with high-concentration (2.5% ~ 4.0%) sevoflurane for anesthesia maintenance, while the observation group was given DEX combined with low-concentration (1.0% ~ 2.0%) sevoflurane for anesthesia maintenance. The anesthetic effect of the two groups was compared.Results Comparison of HR, MAP, CaO₂ , CvO₂ , and ACTH, cortisil and AD levels at T₀ , T₁ and T₂ between the observation group and the control group showed that they were different across the time points (P < 0.05). There was no statistically significant difference in HR and MAP between the observation group and the control group (P > 0.05). There were statistically significant differences in CaO₂ , CvO₂ , and ACTH, cortisil and AD levels between the observation group and the control group (P < 0.05). In addition, the change trends of HR, MAP, CaO₂ , CvO₂ , and ACTH, cortisil and AD levels showed statistically significant differences (P < 0.05). The recovery time of spontaneous breathing and the time to first exhaust in the observation group were both shorter than those in the control group (P < 0.05). The differences in MMSE, VAS and MoCA scores before and 48 hours after the operation were all greater in the observation group than in the control group (P < 0.05). The overall incidence of adverse reactions in the observation group was lower than that in the control group (P < 0.05).Conclusion In patients with lower extremity fractures, anesthesia with DEX combined with low-concentration sevoflurane attenuates hemodynamic fluctuations, mitigates cognitive dysfunction, elicits a milder stress response, and is associated with a lower incidence of anesthesia-related adverse events.