Ma Pu, Zeng Haibo
Department of Anesthesiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology Wuhan, Hubei Province, China.
Am J Transl Res. 2021 Jun 15;13(6):6457-6467. eCollection 2021.
To investigate the effect of dexmedetomidine (DEX) combined with epidural anesthesia on blood pressure, sedation, analgesia and serum β-endorphin levels in patients with hip fractures.
A total of 260 patients with hip fractures were randomly divided into the control group and the experimental group by random number table, with 130 cases in each group. During the perioperative period, the control group was anesthetized with sufentanil combined midazolam, while the experimental group was anesthetized with sufentanil with DEX. In this study, we observed the vital signs and evaluated Ramsay scores at 15 minutes (T1), 30 minutes (T2), 60 minutes (T3), and 90 minutes (T4) after anesthesia. The analgesic effect was obtained using Visual Analogue Scale (VAS) scores at 2 hours (H1), 6 hours (H2), 12 hours (H3), and 24 hours (H4) after operation. The collected blood was used to determine the levels of nitric oxide (NO), endorphin (β-EP), substance P (SP), gamma-interferon (IFN-γ), and tumor necrosis factor-α (TNF-α) by enzyme-linked immuno sorbent assay (ELISA). We also recorded the incidence of adverse reactions during the observation period.
Compared with the control group, the experimental group had higher systolic blood pressure (SBP) at T1, T2 and T3, higher diastolic blood pressure (DBP) at T2, higher rate-pressure product (RPP) at T3 and T4, and lower heart rate (HR) at T1, T2 and T3 (all P<0.05). Compared with the control group, the experimental group had higher Ramsay scores at T2 and T3 (P<0.05). The control group had a difference in Ramsay scores at T2 and T3 compared to T1 (P<0.05). Ramsay scores of the experimental group at T4 were different from that at T1 (P<0.05). Compared with the control group, the experimental group had higher visual analogue scale (VAS) scores at H1, H2, and H3 (P<0.05), while the VAS scores at H3 were lower than those at H1, and the VAS scores at H4 were lower than those at H3 (P<0.05). After operation, the levels of NO, β-EP, SP and IFN-γ in the experimental group were lower than those in the control group (P<0.05), but the level of TNF-α was higher than that in the control group (P<0.05). The number of PCIA analgesic compressions and the dosage of sufentanil in the experimental group were different from those in the control group (P<0.05). There was no statistical difference in the adverse reactions between experimental group and control groups (P>0.05).
Compared with midazolam, the effect of DEX combined with epidural anesthesia for the hip fracture was better. It can maintain patient's vital signs and up-regulate β-endorphin for rapid analgesia and sedation.
探讨右美托咪定（DEX）联合硬膜外麻醉对髋部骨折患者血压、镇静、镇痛及血清β-内啡肽水平的影响。
将260例髋部骨折患者采用随机数字表法随机分为对照组和试验组，每组130例。围手术期，对照组采用舒芬太尼联合咪达唑仑麻醉，试验组采用舒芬太尼联合DEX麻醉。本研究观察麻醉后15分钟（T1）、30分钟（T2）、60分钟（T3）和90分钟（T4）的生命体征并评估Ramsay评分。术后2小时（H1）、6小时（H2）、12小时（H3）和24小时（H4）采用视觉模拟评分法（VAS）评分获得镇痛效果。采集血液采用酶联免疫吸附测定（ELISA）法测定一氧化氮（NO）、内啡肽（β-EP）、P物质（SP）、γ-干扰素（IFN-γ）和肿瘤坏死因子-α（TNF-α）水平。观察期间记录不良反应发生率。
与对照组比较，试验组T1、T2和T3时收缩压（SBP）较高，T2时舒张压（DBP）较高，T3和T4时心率-血压乘积（RPP）较高，T1、T2和T3时心率（HR）较低（均P<0.05）。与对照组比较，试验组T2和T3时Ramsay评分较高（P<0.05）。对照组T2和T3时Ramsay评分与T1比较有差异（P<0.05）。试验组T4时Ramsay评分与T1比较有差异（P<0.05）。与对照组比较，试验组H1、H2和H3时视觉模拟评分（VAS）较高（P<0.05），而H3时VAS评分低于H1，H4时VAS评分低于H3（P<0.05）。术后，试验组NO、β-EP、SP和IFN-γ水平低于对照组（P<0.05），但TNF-α水平高于对照组（P<0.05）。试验组PCIA镇痛按压次数和舒芬太尼用量与对照组不同（P<0.05）。试验组与对照组不良反应差异无统计学意义（P>0.05）。
与咪达唑仑比较，DEX联合硬膜外麻醉用于髋部骨折效果更佳。可维持患者生命体征，上调β-内啡肽实现快速镇痛和镇静。
