右美托咪定联合腰硬阻滞麻醉在股骨粗隆间骨折患者中的应用效果

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Abstract Objective To explore the effect of Dexmedetomidine combined with spinal epidural anesthesia in patients with femoral intertrochanteric fractures. Methods A total of 106 patients with intertrochanteric fractures of the femur admitted to Jurong City Hospital of Traditional Chinese Medicine from January 2019 to December 2020 were selected as the research objects. They were divided into the control group (53 cases) and the observation group (53 cases) according to the random number table method. Both groups were given spinal epidural anesthesia. In the control group,normal saline was pumped within 15 minutes after successful anesthesia and continued to 30 minutes before the end of the operation. The observation group was given Dexmedetomidine in the same way. The hemodynamics, stress response indicators, cognitive function, and adverse reactions occur of the two groups were compared. Results At 5 minutes before anesthesia (T0), there were no statistically significant differences of heart rate (HR), meverage arterial pressure(MAP) between the two groups (P>0.05). At 10 minutes after anesthesia (T1), the end of the operation (T2), postoperative 1 hours (T3), the HR and MAP of the observation group were lower than that of the control group at the same period,with statistically significant differences (P＜0.05). At T1, T2, T3, the HR and MAP of the control group were higher than that at T0 in the group, with statistically significant differences (P＜0.05). At T2, the HR and MAP of the observation group were higher than that at T0 in the group, with statistically significant differences (P＜0.05). At T0, there were no statistically significant differences of cortisol (Cor), blood glucose (GLU) between the two groups (P>0.05). At T1, T2, T3,the Cor and GLU of the observation group were lower than that of the control group at the same period, with statistically significant differences (P＜0.05). At T1, T2, T3, the Cor and GLU of the control group were lower than that of at T0 in the group, with statistically significant differences (P＜0.05). At T2, the Cor of the observation group was higher than that at T0 in the group, with statistically significant difference (P＜0.05). At T1, T2, the GLU of the observation group was higher than that at T0 in the group, with statistically significant difference (P＜0.05). At T0, there was no statistically significant difference of mini-mental state examination(MMSE)score between the two groups(P>0.05).On 1,3,7 days after surgery,the MMSE score of the two groups were lower than those before surgery in the group, with statistically significant differences (P＜0.05). On 1, 3, 7 days after surgery, the MMSE score of the observation group were higher than those of the control group on the same period, with statistically significant differences (P＜0.05). There was no statistically significant difference of total incidence of adverse reactions between the two groups (P>0.05). Conclusion Dexmedetomidine combined with spinal epidural anesthesia is effective in patients with intertrochanteric fractures. It can ensure stable hemodynamics, control stress response, less cognitive impairment, and no serious adverse reactions. It is safe feasible.

Key words： Intertrochanteric fracture of femur Dexmedetomidine Lumbar epidural anesthesia Hemodynamics Stress response

Received: 21 June 2021

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