右美托咪定复合小剂量瑞芬太尼在老年患者髋关节置换术中的静脉优化效应

目的 探讨右美托咪定(DEX)复合小剂量瑞芬太尼对腰丛-坐骨神经阻滞下老年髋关节置换术患者术中的静脉优化效应.方法 选取2018年7月-2020年7月在文昌市人民医院行髋关节置换术的老年患者90例,采用随机对照表法分为A组、B组和C组,每组30例.A组给予DEX泵注,B组给予小剂量瑞芬太尼泵注,C组给予小剂量瑞芬太尼持...

Intravenous optimization effect of dexmedetomidine combined with low dose remifentanil on elderly patients undergoing hip arthroplasty

  Objective  To investigate the anesthetic effect of dexmedetomidine (DEX) combined with low dose remifentanil on elderly patients undergoing hip arthroplasty with lumbar plexus-sciatic nerve block.  Methods  A total of 90 elderly patients undergoing hip arthroplasty in our hospital from July 2018 to July 2020 were randomly divided into group A, B and C, with 30 patients in each group. Group A was given DEX pump injection, group B was given small dose remifentanil pump injection, group C was given small dose remifentanil continuous pump injection combined with DEX pump injection, the injection dose was the same as that of group A and B. All groups were treated with lumbar plexus-sciatic nerve block guided by ultrasound combined with nerve stimulation 10 minutes after administration. Hemodynamics, analgesia and sedation effects were observed and compared in each group, and patients ' satisfaction with anesthesia effect was compared.  Results  After nerve block (T1), MAP of group B and C was significantly lower than that of group A (all P < 0.05). At 15min (T2), 30 min (T3) after operation and operation completion (T4), the MAP of group C was significantly lower than that of groups A and B (all P < 0.05), and that of group B was significantly lower than that of group A (all P < 0.05). At T2-T4, HR in group C was significantly lower than that in groups A and B (all P < 0.05). At T1-T4, RR in groups B and C was significantly lower than that in group A (all P < 0.05). At T1-T4, VAS score in group C was significantly lower than that in groups A and B (all P < 0.01). At T1-T2, BIS in group C was significantly lower than that in groups A and B (all P < 0.01), and BIS in group A was significantly lower than that in group B (all P < 0.05). At T3-T4, BIS in group B was significantly higher than that in group A and C (all P < 0.01). The anesthesia satisfaction of group C (96.67%) was significantly higher than that of group A (66.67%) and B (66.67%, χ2=9.017, P=0.003).  Conclusion  In elderly patients undergoing hip replacement under lumbar plexus-sciatic nerve block anesthesia, intraoperative administration of DEX combined with low-dose remifentanil continuous pumping can effectively maintain hemodynamic stability, and provide better analgesia and sedative effects, with small adverse reactions, which is worthy of clinical promotion.