右美托咪啶在高龄患者腰丛联合坐骨神经阻滞下全髋关节置换术中的辅助效果观察

目的观察右美托咪啶(Dex)在高龄患者腰丛联合坐骨神经阻滞下全髋关节置换术中的辅助效果。方法39例高龄腰丛联合坐骨神经阻滞下全髋关节置换术病例均选取自2011年1月—2012年12月间骨伤科收治的患者,采用数字随机分组原则进行临床分组,观察组21例,对照组18例。对照组采用常规麻醉及维持麻醉方案,观察组在对照组基础上使用Dex静滴,观察两组患者T0(术后30 min)、T1(2 h)、T2(4 h)、T3(12 h)、T4(24 h)、T5(48 h)段内视觉模拟评分(visual analogue scale,VAS)、Ramsay镇静评分、不良反应发生率等情况。计量资料采用t检验,计数资料采用χ2检验,P0.05为差异有统计学意义。结果除T5外观察组VAS评分T0、T1、T2、T3、T4均明显低于对照组,两组比较差异均有统计学意义(均P0.05),两组各时间段Ramsay镇静评分比较差异均无统计学意义(均P0.05)。观察组不良反应发生率为9.52%,对照组为38.89%,两组比较差异有统计学意义(P0.05)。结论 Dex在高龄患者腰丛联合坐骨神经阻滞下全髋关节置换术中具有显著的止痛效果,且不良反应较小,值得临床使用。

Observation on dexmedetomidine in combined lumbar plexus and sciatic nerve block for total hip replacement in the elderly

Objective To observe the auxiliary effect of dexmedetomidine in combined lumbar plexus and sciatic nerve block for total hip replacement in the elderly. Methods 39 elderly cases receiving combined lumbar plexus and sciatic nerve block for total hip replacement in our hospital were selected from Jan. 2011 to Dec. 2012. They were divided into two groups with random numbers table ： observation group （ n = 21 ） and control group （ n = 18 ）. Routine anesthetic man- agement and maintenance of anesthesia were applied to both groups. Dexmedetomidine （Dex） was administered intrave- nously to observation group in addition. Both groups were observed for VAS （visual analogue scale） score, Ramsay score, and the incidence of adverse reactions at To（30min after operation）, T1 （2h） ,T2（4h） ,T3（12h） ,T4（24h）,T5 （48h）. Measurement data were processed by t test, count data by X2 test, the result of P 〈 0.05 was considered statistically significant. Results In addition to 1＂5, VAS scores were significantly lower at TO, T1 ,T2, T3 and T4 in observation group than in control group, showing statistically significant difference （ P 〈 0.05）. However, no significant difference was found between the two groups in Ramsay score（ P 〉 0.05 ）. The incidence of adverse reactions was 9.52% in observation group and 38.89% in control group,, showing statistically significant difference （P 〈 0.05 ）. Conclusions Dex shows potent anal- gesic efficacy in combined lumbar plexus and sciatic nerve block for total hip replacement in the elderly, and has less ad- verse reactions, which is worthy of clinical use.