2022 年第 4 期 第 17 卷

右美托咪定术后镇痛对肩关节镜手术患者血流动力学与简易智力状态检查量表评分的影响

Effects of dexmedetomidine postoperative analgesia on hemodynamics and mini-mental state examimation score in patients undergoing shoulder arthroscopic surgery

作者：祝家群彭文勇

英文作者：Zhu Jiaqun Peng Wenyong

单位：浙江大学医学院附属金华医院麻醉科，金华321000

英文单位：Department of Anesthesiology Affiliated Jinhua Hospital Zhejiang University School of Medicine Jinhua 321000 China

关键词：肩关节镜术；右美托咪定；血流动力学；认知功能；疼痛；不良反应

英文关键词：Shoulderarthroscopicsurgery;Dexmedetomide;Hemodynamics;Cognitivefunction;Pain;Adversereactions

• 摘要：

• 目的 探讨右美托咪定术后镇痛对肩关节镜手术患者血流动力学与简易智力状态检查量表（MMSE）评分的影响。方法 选取2019年1月至2021年1月在浙江大学医学院附属金华医院接受肩关节镜手术的120例患者，采用随机数字表法分为观察组（60例）与对照组（60例）。观察组术后予自控静脉镇痛静脉泵注0.5 μg/kg右美托咪定，而对照组患者术后予自控静脉镇痛泵注等容积的0.9%氯化钠注射液。比较2组术前及术后48 h的血流动力学、疼痛与镇静评分，术前和术后12、48 h MMSE评分，以及术后不良反应发生情况。结果 术后48 h，2组心率、收缩压、舒张压、疼痛视觉模拟量表评分与Ramsay镇静评分均低于术前且观察组低于对照组［(93±6)次/min比(98±6)次/min、(110±7)mmHg(1 mmHg=0.133 kPa)比(120±7)mmHg、(72±7)mmHg比(80±7)mmHg、(3.05±0.29)分比(3.77±0.31)分、(2.5±0.4)分比(3.0±0.3)分］，差异均有统计学意义（均P＜0.05）。术后12、48 h，观察组MMSE评分均高于对照组［(21.4±2.0)分比(18.3±2.0)分、(24.1±1.8)分比(22.1±1.8)分］，差异均有统计学意义（均P＜0.001）。观察组不良反应发生率明显低于对照组［3.3%(2/60)比15.0%(9/60)］，差异有统计学意义（P=0.027）。结论 右美托咪定对肩关节镜手术患者有较好的镇痛、镇静作用，对血流动力学干扰小，能改善患者术后认知功能，减少不良反应的发生。

• Objective To investigate the effects of dexmedetomidine postoperative analgesia on hemodynamics and mini-mental state examimation (MMSE) score in patients undergoing shoulder arthroscopic surgery. Methods Totally 120 patients who underwent shoulder arthroscopic surgery in Affiliated Jinhua Hospital, Zhejiang University School of Medicine from January 2019 to January 2021 were enrolled. Patients were randomly divided into observation group (60 cases) and control group (60 cases). After surgery, the observation group was given patient-controlled intravenous analgesia of 0.5 μg/kg dexmedetomidine pumping, while the control group was given patient-controlled intravenous analgesia of equal volume of 0.9% sodium chloride injection pumping. The hemodynamics, pain and sedation scores, MMSE score before, 12 and 48 h after operation were compared between the two groups. Results At 48 h after operation, the heart rate, systolic blood pressure, diastolic blood pressure, pain visual analogue scale score and Ramsay sedation score of both groups were lower than those before operation, and those in the observation group were lower than those in the control group［(93±6)times/min vs (98±6)times/min, (110±7)mmHg vs (120±7)mmHg, (72±7)mmHg vs (80±7)mmHg, (3.05±0.29) vs (3.77±0.31), (2.5±0.4) vs (3.0±0.3)］(all P＜0.05). At 12 and 48 h after operation, the MMSE score in the observation group was higher than that in the control group［(21.4±2.0) vs (18.3±2.0), (24.1±1.8) vs (22.1±1.8)］(both P＜0.001). The incidence of adverse reactions in the observation group was significantly lower than that in the control group ［3.3%(2/60) vs 15.0%(9/60)］, and the difference was statistically significant (P=0.027). Conclusions Dexmedetomidine has good analgesic and sedative effects on patients undergoing shoulder arthroscopic surgery. It has less interference on hemodynamics, and can improve patients′ postoperative cognitive function and reduce the occurrence of adverse reactions.