2026 年第 3 期 第 21 卷

地塞米松联合右美托咪定用于老年髋部骨折术后镇痛的疗效研究

Efficacy study of dexamethasone combined with dexmedetomidine for postoperative analgesia in elderly patients with hip fracture

作者：江淑严1柯铭潮1张奕文2黄德辉1

英文作者：Jiang Shuyan1， Ke Mingchao1， Zhang Yiwen2， Huang Dehui1

单位：1广东医科大学东莞市人民医院麻醉科广东医科大学第一临床医学院，东莞523109；2南方医科大学第八附属医院麻醉科，佛山528300

英文单位：1Department of Anesthesiology Dongguan People′s Hospital Affiliated to Guangdong Medical University The First School of Clinical Medicine Guangdong Medical University Dongguan 523109 China; 2Department of Anesthesiology the Eighth Affiliated Hospital of Southern Medical University Foshan 528300 China

关键词：髋关节置换术；地塞米松；右美托咪定；术后疼痛

英文关键词：HipArthroplasty;Dexamethasone;Dexmedetomidine;Postoperativepain

• 摘要：

• 目的 探究地塞米松联合右美托咪定用于老年髋部骨折术后镇痛的疗效。方法 选取2023年12月至2024年12月南方医科大学第八附属医院收治的128例老年髋部骨折患者为研究对象。按照随机数字表法分为对照组和观察组，各64例。对照组麻醉诱导前泵注右美托咪定；观察组麻醉诱导前联合泵注右美托咪定与地塞米松。比较2组术后镇痛情况、苏醒时间、认知功能、脑氧代谢、肾功能、不良反应情况。结果 观察组首次按压镇痛泵时间长于对照组，术后24 h按压次数和舒芬太尼用量、术后12、24、48 h VAS评分均少于/低于对照组，差异均有统计学意义（均P＜0.05）。2组简易精神状态检查量表评分在术后24 h时下降，在术后48、72 h时上升，且观察组术后24、48 h时简易精神状态检查量表评分均高于对照组，差异均有统计学意义（均P＜0.05）。2组术后24 h时动脉血氧含量、颈内静脉血氧含量水平均降低，且观察组均高于对照组，差异均有统计学意义（均P＜0.05）。2组术后24 h时血肌酐、血尿素氮水平均上升，且观察组低于对照组，差异均有统计学意义（均P＜0.05）。观察组和对照组不良反应发生率比较，差异无统计学意义［14.1%（9/64）比9.4%（6/64）］（χ2=0.680，P=0.410）。结论 地塞米松联合右美托咪定可提高老年髋部骨折术后镇痛效果，减少老年患者术后认知损伤，改善脑氧代谢，减轻肾损伤，且安全性良好。

• Objective To investigate the efficacy of dexamethasone combined with dexmedetomidine in postoperative analgesia for elderly patients with hip fracture. Methods A total of 128 elderly patients with hip fracture admitted to the Eighth Affiliated Hospital of Southern Medical University from December 2023 to December 2024 were selected as the research objects. They were divided into the control group and the observation group according to the random number table method, with 64 cases in each group. The control group was pumped with dexmedetomidine before anesthesia induction; the observation group was pumped with dexmedetomidine combined with dexamethasone before anesthesia induction. The postoperative analgesia, awakening time, cognitive function, cerebral oxygen metabolism, renal function and adverse reactions were compared between the two groups. Results The time of the first pump pressing in the observation group was longer than that in the control group, the number of pump pressings and sufentanil dosage within 24 h after operation, and the VAS scores at 12 h, 24 h and 48 h after operation were less/lower than those in the control group (all P＜0.05). The mini-mental state examination scores of both groups decreased at 24 h after operation and increased at 48 h and 72 h after operation, and the mini-mental state examination scores of the observation group at 24 h and 48 h after operation were higher than those of the control group (all P＜0.05). The levels of arterial oxygen content and jugular venous oxygen content in both groups decreased at 24 h after operation, and those in the observation group were higher than those in the control group (all P＜0.05). The levels of serum creatinine and blood urea nitrogen in both groups increased at 24 h after operation, and those in the observation group were lower than those in the control group (all P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the observation group and the control group ［14.1%(9/64) vs 9.4%(6/64)］(χ2=0.680, P=0.410). Conclusion Dexamethasone combined with dexmedetomidine can improve the postoperative analgesic effect in elderly patients with hip fracture, reduce postoperative cognitive impairment, improve cerebral oxygen metabolism, alleviate renal damage, and has good safety.