文章摘要
右美托咪定滴鼻联合髂筋膜间隙阻滞在老年髋部骨折患者围术期的应用效果
Effect of dexmedetomidine nasal drop combined with fascia iliaca compartment block in elderly patients with hip fracture during perioperative period
  
DOI：10.12089/jca.2022.12.003
中文关键词: 右美托咪定  髂筋膜间隙阻滞  老年  髋部骨折  术后转归
英文关键词: Dexmedetomidine  Fascia iliaca compartment block  Elderly  Hip fracture  Postoperative outcome
基金项目:
作者单位E-mail
谈世刚 430070,武汉市,中部战区总医院麻醉科  
周翔 430070,武汉市,中部战区总医院麻醉科  
鲁汉杰 430070,武汉市,中部战区总医院麻醉科  
阮剑辉 430070,武汉市,中部战区总医院麻醉科  
宋晓阳 430070,武汉市,中部战区总医院麻醉科 songxiaoyang1234@163.com 
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中文摘要:
      
目的 探讨右美托咪定滴鼻联合髂筋膜间隙阻滞在老年髋部骨折患者围术期的应用效果。
方法 选择择期行腰-硬联合麻醉下髋部骨折手术的老年患者59例，男14例，女45例，年龄≥65岁，BMI 14.1～30.3 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：右美托咪定滴鼻联合髂筋膜间隙阻滞组（D组，n=29）和髂筋膜间隙阻滞组（F组，n=30）。术前1 d晚间D组给予右美托咪定滴鼻后在超声引导下行患侧髂筋膜间隙阻滞，F组仅在超声引导下行患侧髂筋膜间隙阻滞。记录右美托咪定滴鼻前（T1）、髂筋膜间隙阻滞后1 h（T2）、过转运床即刻（T3）、过手术床即刻（T4）、摆体位时（T5）的HR、MAP、SpO2和疼痛数字评价量表（NRS）评分。记录术前1 d、手术当日及术后1、2 d的汉密尔顿焦虑（HAM-A）评分和里兹睡眠问卷（LSEQ）评分。记录术后7 d内谵妄发生情况及术后住院时间。记录低血压、心动过缓以及术后48 h内恶心呕吐、头晕、日间嗜睡等不良反应的发生情况。
结果 与T1时比较，T3—T5时F组HR明显增快，MAP明显升高，D组NRS明显降低（P<0.05）；与F组比较，T3—T5时D组HR明显减慢，MAP和NRS明显降低（P<0.05）。与术前1 d比较，手术当日及术后1、2 d D组HAM-A评分明显降低，LSEQ评分明显增高，F组LSEQ评分明显增高（P<0.05）。与F组比较，手术当日及术后1、2 d D组LSEQ评分明显增高，HAM-A评分明显降低（P<0.05）。与F组比较，D组术后住院时间明显缩短，术后7 d谵妄总发生率明显降低，日间嗜睡发生率明显降低（P<0.05）。
结论 老年髋部骨折手术患者术前右美托咪定滴鼻联合髂筋膜间隙阻滞可使术前血流动力学更加稳定，同时减轻术前疼痛，降低焦虑及术后谵妄发生率，提高围术期睡眠质量，缩短术后住院时间。
英文摘要:
      
Objective To investigate the effect of dexmedetomidine nasal drop combined with fascia iliaca compartment block in elderly patients with hip fracture during perioperative period.
Methods Fifty-nine elderly patients with hip fracture under combined spinal-epidural anesthesia were selected, including 14 males and 45 females, aged ≥65 years, BMI 14.1-30.3 kg/m2, ASA physical status Ⅱ or Ⅲ. The patients were randomly divided into two groups: dexmedetomidine nasal drop combined with iliofascial space block group (group D, n = 29) and iliac fascia space block group (group F, n = 30). Group D was treated with dexmedetomidine nasal drop combined with ultrasound-guided fascia iliaca compartment block 1 day before operation, and group F was treated with ultrasound-guided fascia iliaca compartment block 1 day before operation. The HR, MAP, SpO2 and pain numerical rating scale (NRS) score were recorded before dexmedetomidine nasal drop (T1), 1 hour after fascia iliaca compartment block (T2), immediately passing through the transfer bed (T3), immediately passing the operating bed (T4) and positioning (T5). The scores of Hamilton rating scale for anxiety (HAM-A) and Leeds sleep evaluation questionaire (LSEQ) were recorded 1 day before operation, on the day of operation, and on the morning of 1 day and 2 days after operation. The total incidence of delirium and postoperative hospital stay were recorded 7 days after operation. The adverse reactions such as hypotension, bradycardia, nausea and vomiting, dizziness and daytime sleepiness within 48 hours after operation were recorded.
Results Compared with T1, HR and MAP increased significantly in group F during T3-T5, NRS was significantly lower in group D during T3-T5 (P < 0.05). Compared with group F, HR, MAP and NRS were decreased significantly in group D during T3-T5(P < 0.05). Compared with 1 day before operation, and the score of HAM-A was significantly decreased, the score of LSEQ in group D was significantly higher on the operation day, 1 day and 2 days after operation, and score of LSEQ in group F were significantly higher (P < 0.05). Compared with group F, the LSEQ score on the operation day and 1 day and 2 days after operation in group D was significantly higher and the HAM-A score was significantly lower (P < 0.05). Compared with group F, the total incidence of delirium within the postoperative hospital stay, 7 days after operation and the incidence of daytime sleepiness were significantly lower in group D (P < 0.05).
Conclusion Dexmedetomidine nasal drop combined with fascia iliaca compartment block in elderly patients with hip fracture can make the hemodynamics more stable, reduce preoperative pain, the incidence of anxiety and postoperative delirium, and improve perioperative sleep quality, and shorten postoperative hospital stay.
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