2021 年第 12 期 第 16 卷

右美托咪定复合罗哌卡因对老年下肢骨折患者术后镇痛效果及认知功能的影响

Impact of dexmedetomidine combined with ropivacaine on postoperative analgesia and cognitive function in elderly patients with lower limb fractures

作者：陆瑞斌1蒋涛2许旭东1邹鲁1

英文作者：Lu Ruibin1 Jiang Tao2 Xu Xudong1 Zou Lu1

单位：1江苏省常州市中医医院麻醉科213000；2江苏省常州市中医医院骨伤科213000

英文单位：1Department of Anesthesiology Changzhou Hospital of Traditional Chinese Medicine Jiangsu Province Changzhou 213000 China; 2Department of Orthopaedics Changzhou Hospital of Traditional Chinese Medicine Jiangsu Province Changzhou 213000 China

关键词：下肢骨折；右美托咪定；罗哌卡因

英文关键词：Lowerlimbfractures;Dexmedetomidine;Ropivacaine

• 摘要：

• 目的 探讨右美托咪定复合罗哌卡因对老年下肢骨折患者术后镇痛效果及认知功能的影响。方法 选取2018年3月至2021年3月江苏省常州市中医医院收治的择期行下肢骨折手术的老年患者84例，采用随机数字表法将其分为罗哌卡因组、复合组，每组42例。术中均行罗哌卡因腰硬联合麻醉术，术后罗哌卡因组采用罗哌卡因自控镇痛，复合组采用右美托咪定复合罗哌卡因自控镇痛。对比2组术后疼痛视觉模拟量表（VAS）评分、睡眠质量［匹兹堡睡眠质量指数（PSQI）评分］、谵妄发生率以及不良反应发生情况。结果  复合组术后6、8、12 h 静息及运动状态VAS评分低于罗哌卡因组，2组术后8、12 h静息及运动状态VAS评分均高于术后2 h，差异均有统计学意义（均P＜0.05）。与术前比较，2组术后当晚、术后12 h PSQI评分均高于术前，但复合组低于罗哌卡因组［（12.2±2.0）分比（13.1±2.0）分、（8.5±1.7）分比（9.4±1.8）分］，差异均有统计学意义（均P<0.05）。复合组术后第1、2天谵妄发生率低于罗哌卡因组［11.9%（5/42）比31.0%（13/42）、4.8%（2/42）比21.4%（9/42）］，差异均有统计学意义（均P＜0.05）。2组术后不良反应发生率差异均无统计学意义（均P＞0.05）。结论  右美托咪定复合罗哌卡因对老年下肢骨折术后镇痛效果明显，可提高患者睡眠质量，降低谵妄发生率，促进老年下肢骨折患者伤口愈合。

• Objective To explore the impact of dexmedetomidine combined with ropivacaine on postoperative analgesia and cognitive function in elderly patients with lower limb fractures. Methods From March 2018 to March 2021, 84 elderly patients who underwent elective surgery for lower limb fractures in Changzhou Hospital of Traditional Chinese Medicine, Jiangsu Province were enrolled. They were divided into ropivacaine group and compound group by the random number table method, with 42 cases in each group. All patients underwent ropivacaine spinal epidural anesthesia. After surgery, the ropivacaine group received patient-controlled analgesia with ropivacaine, and the compound group received patient-controlled analgesia with dexmedetomidine and ropivacaine. The pain visual analogue scale (VAS) score, sleep quality［Pittsburgh sleep quality index (PSQI) score］, incidence of delirium, and adverse reactions were compared between the two groups after surgery. Results The VAS scores of resting and motor state at 6, 8 and 12 h after surgery in the compound group were lower than those in the ropivacaine group, and the VAS scores of resting and motor state at 8 and 12 h after surgery in the two groups were higher than those at 2 h after surgery(all P<0.05). The PSQI scores of the two groups on the night and at 12 h after surgery were higher than those before surgery, but those in the compound group was lower than those in the ropivacaine group［（12.2±2.0）vs （13.1±2.0）,（8.5±1.7）vs （9.4±1.8）］(all P<0.05). The incidence of delirium on the 1st and 2nd days after surgery in the compound group was lower than that in the ropivacaine group［11.9%(5/42) vs 31.0%(13/42), 4.8%(2/42) vs 21.4%(9/42)］（both P<0.05）. There was no significant difference in the incidence of postoperative adverse reactions between the two groups(all P>0.05). Conclusions   Dexmedetomidine combined with ropivacaine has a significant effect on postoperative analgesia for elderly patients with lower limb fractures. It can improve sleep quality, reduce the incidence of delirium, and promote wound healing in elderly patients with lower limb fractures.