Effect of dexmedetomidine combined with subarachnoid block anesthesia on closed reduction and internal fixation for elderly patients with femoral fracture

doi:10.3760/cma.j.issn.1007-1245.2023.04.008

Abstract

Abstract:

Objective　To investigate the effect of dexmedetomidine combined with subarachnoid block anesthesia on closed reduction and internal fixation for elderly patients with femoral fracture. Methods　From January 2019 to January 2022, 78 patients with femoral fracture treated by closed reduction and internal fixation in Bayannaoer City Hospital were selected as the research objects. They were divided into a control group and a treatment group by the random number table method, with 39 cases in each group. In the control group, there were 19 women and 20 men; they were 60-76 (67.45±5.63) old; the course of disease was 2-9 (4.15±0.36) days. In the treatment group, there were 18 women and 21 men; they were 61-75 (66.98±5.52) years old; the course of disease was 2-9 (4.24±0.39) days. The control group were given dexmedetomidine + spinal and epidural anesthesia, and the treatment group dexmedetomidine+subarachnoid block anesthesia. The changes of hemodynamic indicators during operation were recorded; the stress reaction and pain during perioperative period were compared between the two groups. χ² test was used for the enumeration data, t test and F test for measurement data. Results　Compared with those in the control group, the changes of heart rate and mean artery pressure(MAP) in the treatment group were gentle and the relative hemodynamics were relatively stable (F_time=9.632 and 9.741, both P<0.001). There were statistical differences in heart rate and MAP between the treatment group and the control group (F_group=9.365 and 8.644, both P<0.001). There were statistical differences in heart rate and MAP treands between the treatment group and the control group (F_interactive=8.635 and 8.744, both P<0.001). There were differences in adrenaline (Adr) and cortisol (Cor) between different time points (F_time=9.652 and 7.625, both P<0.001). The level of Adr and Cor in the treatment group were lower than those in the control group, with statistical differences (F_group=8.551 and 7.968, both P<0.001). There were statistical differences in the Adr and Cor trends between the treatment group and the control group (F_interactive=9.582 and 7.582, both P<0.001). The stress response during the perioperative period in the treatment was milder than that in the control group. The Visual Analogue Scale (VAS) scores between different time points were statistically significant (F_time=8.025, P<0.001). There was a statistical difference in the VAS score between the treatment group and the control group (F_group=9.658, P<0.001). The VAS score in the treatment group was lower than that in the control group, and the analgesic effect was better (F_interactive=8.569, P<0.001). Conclusion　Dexmedetomidine combined with subarachnoid block anesthesia for elderly patients with femoral fracture treated by closed reduction and internal fixation can stabilize their hemodynamic indicators and inhibit their stress reaction during the operation, and reduce the postoperative pain.

Key words:

Dexmedetomidin, Subarachnoid block anesthesia, Elderly patients with femoral fracture, Closed reduction and internal fixation, , Hemodynamics

摘要：

目的　探讨右美托咪定联合蛛网膜下腔阻滞麻醉对老年股骨骨折闭合复位内固定术的疗效分析。方法　选取2019年1月至2022年1月巴彦淖尔市医院收治的78例股骨骨折闭合复位内固定术患者为研究对象，随机数字表法分为对照组、治疗组，各39例。对照组中，女19例，男20例；年龄60～76（67.45±5.63）岁；病程2～9（4.15±0.36）d。治疗组中，女18例，男21例；年龄61～75（66.98±5.52）岁；病程2～9（4.24±0.39）d。对照组给予右美托咪定+腰硬联合麻醉，治疗组给予右美托咪定+蛛网膜下腔阻滞麻醉。记录两组患者术中血流动力学指标变化情况，比较两组患者围术期应激反应及疼痛情况。计数资料采用χ²检验，计量资料采用t检验、F检验。结果　治疗组与对照组相比心率、平均动脉压（MAP）变化平缓，相对血流动力学较稳定（F_时间=9.632、9.741，均P<0.001），治疗组与对照组的心率、MAP比较，差异均有统计学意义（F_组间=9.365、8.644，均P<0.001），治疗组与对照组的心率、MAP变化趋势比较，差异均有统计学意义（F_交互=8.635、8.744，均P<0.001）。不同时间点的肾上腺素（Adr）、皮质醇（Cor）比较，差异均有统计学意义（F_时间=9.652、7.625，均P<0.001）；治疗组的Adr、Cor低于对照组，差异均有统计学意义（F_组间=8.551、7.968，均P<0.001）；治疗组与对照组的Adr、Cor变化趋势比较，差异均有统计学意义（F_交互=9.582、7.582，均P<0.001）。相比对照组，治疗组围术期应激反应轻较。不同时间点的视觉模拟量表（VAS）评分比较，差异有统计学意义（F_时间=8.025，P<0.001），治疗组与对照组的VAS评分比较，差异有统计学意义（F_组间=9.658，P<0.001），治疗组VAS评分低于对照组，镇痛效果较好（F_交互=8.569，P<0.001）。结论　右美托咪定联合蛛网膜下腔阻滞麻醉用于老年股骨骨折闭合复位内固定术可稳定术中血流动力学指标，抑制患者围术期应激反应，减轻术后疼痛。

关键词:

右美托咪定, 蛛网膜下腔阻滞麻醉, 老年股骨骨折, 闭合复位内固定术, 血流动力学

Li Shuai, Rao Kong, Duan Zhiqiang, Hao Zhi.

Effect of dexmedetomidine combined with subarachnoid block anesthesia on closed reduction and internal fixation for elderly patients with femoral fracture [J]. International Medicine and Health Guidance News, 2023, 29(4): 475-479.

李帅饶孔段志强郝智.

右美托咪定联合蛛网膜下腔阻滞麻醉对老年股骨骨折闭合复位内固定术的疗效分析 [J]. 国际医药卫生导报, 2023, 29(4): 475-479.

References

[1] 甘霖,李有长,雷晓峰,等.蛛网膜下腔阻滞麻醉复合右美托咪定用于截瘫产妇剖宫产1例分析[J].现代医药卫生,2022,38(15):2689-2692.DOI:10.3969/j.issn.1009-5519. 2022.15.043.
[2] 吴友平,彭捷,邵伟栋,等.静脉注射右美托咪定或咪达唑仑对蛛网膜下腔阻滞麻醉效果影响的Meta分析[J].医学综述,2022,28(2):386-393,399.DOI:10.3969/j.issn. 1006-2084. 2022.02.030.
[3] 黄奎挺,邵雪泉.右美托咪定辅助蛛网膜下腔阻滞麻醉对老年患者髋关节置换术后早期康复的影响[J].现代实用医学,2021,33(2):240-242.DOI:10.3969/j.issn.1671-0800. 2021.02.051.
[4] 张高行,高旭琴,陈丽,等.右美托咪定对老年原发性高血压病人蛛网膜下腔阻滞麻醉穿刺前后血流动力学的影响[J].中西医结合心脑血管病杂志,2020,18(17):2929-2932.DOI:10.12102/j.issn.1672-1349.2020.17.049.
[5] 中华医学会骨科学分会创伤骨科学组,中国医师协会骨科医师分会创伤专家工作委员会.成人股骨颈骨折诊治指南[J].中华创伤骨科杂志,2018,20(11):921-928.DOI:10.3760/cma.j.issn.1671-7600.2018.11.001.
[6] 宗行万之助.疼痛的估价——用特殊的视觉模拟评分法作参考(VAS)[J].疼痛学杂志,1994,2(4):153.
[7] Zhang X, Baer AG, Price JM, et al. Neurotransmitter networks in mouse prefrontal cortex are reconfigured by isoflurane anesthesia[J]. J Neurophysiol, 2020,123(6):2285-2296. DOI: 10.1152/jn.00092.2020.
[8] Momeni M, Khalifa C, Lemaire G, et al. Propofol plus low-dose dexmedetomidine infusion and postoperative delirium in older patients undergoing cardiac surgery[J]. Br J Anaesth, 2021,126(3):665-673. DOI: 10.1016/j.bja.2020.10.041.
[9] Karpetas GZ, Spyraki MK, Giakoumakis SI, et al. Multimodal analgesia protocol for pain management after total knee arthroplasty: comparison of three different regional analgesic techniques[J]. J Musculoskelet Neuronal Interact, 2021,21(1):104-112.
[10] Tu W, Yuan H, Zhang S, et al. Influence of anesthetic induction of propofol combined with esketamine on perioperative stress and inflammatory responses and postoperative cognition of elderly surgical patients[J]. Am J Transl Res, 2021,13(3):1701-1709.
[11] Obayashi J, Wakisaka M, Tanaka K, et al. Risk factors influencing ascending testis after laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele[J]. Pediatr Surg Int, 2021,37(2):293-297. DOI: 10.1007/s00383-020-04789-8.
[12] Duan S, Zhang P, Lin X, et al. Laparoscopic percutaneous extraperitoneal closure with peritoneum reinforcement repair for pediatric inguinal hernia: a single-center experience with over 2,000 patients[J]. Transl Pediatr, 2021,10(5):1317-1323. DOI: 10.21037/tp-21-25.
[13] Kim YJ, Seo DW, Ko Y, et al. Subcutaneous fat area at the upper thigh level is a useful prognostic marker in the elderly with femur fracture[J]. J Cachexia Sarcopenia Muscle, 2021,12(6):2238-2246. DOI: 10.1002/jcsm.12845.
[14] 杨雨.老年股骨颈骨折围手术期中中医情志护理、穴位按摩的应用效果[J/CD].全科口腔医学杂志(电子版),2019,6(36):69. DOI:10.16269/j.cnki.cn11-9337/r.2019.36.055.
[15] 高敏,齐碌.中医情志护理及穴位按摩在老年股骨颈骨折围手术期的应用[J].新疆中医药,2018,36(5):53-54.
[16] Harsanyi S, Zamborsky R, Krajciova L, et al. Developmental dysplasia of the hip: a review of etiopathogenesis, risk factors, and genetic aspects[J]. Medicina (Kaunas), 2020,56(4):153. DOI: 10.3390/medicina56040153.
[17] Zkan S, Adana C.Comparison of salter osteotomy results in two different age groups in the treatment of developmental hip dislocation[J].Journal of Surgery and Medicine,2020,4(3):199-202. DOI:10.28982/josam. 700839.
[18] Barrera CA, Cohen SA, Sankar WN, et al. Imaging of developmental dysplasia of the hip: ultrasound, radiography and magnetic resonance imaging[J]. Pediatr Radiol, 2019,49(12):1652-1668. DOI: 10.1007/s00247-019-04504-3.
[19] Zhou Y, Ju L, Lou Y, et al. Analysis of acetabulum in children with developmental dysplasia of the hip by MRI scan[J]. Medicine (Baltimore), 2019,98(3):e14054. DOI: 10.1097/MD.0000000000014054.
[20] Zhao E, Liu Z, Ding Z, et al. A propensity score-matched analysis between patients with high hip dislocation after childhood pyogenic infection and Crowe IV developmental dysplasia of the hip in total hip arthroplasty with subtrochanteric shortening osteotomy[J]. J Orthop Surg Res, 2020,15(1):418. DOI: 10.1186/s13018-020-01947-5.
[21] Ramponi DR, Kaufmann J, Drahnak G. Hip Fractures[J]. Adv Emerg Nurs J, 2018,40(1):8-15. DOI: 10.1097/TME.0000000000000180.
[22] Meier ST. Construct validity of Outcome Rating Scale (ORS) scores in clinical samples: extension of Harris, Murphy, and Rakes' (2019) narrative review[J]. J Evid Based Soc Work (2019), 2020,17(6):648-661. DOI: 10.1080/26408066.2020.1784345.
[23] Alnahdi AH. Measurement properties of the 15-item Arabic lower extremity functional scale[J]. Disabil Rehabil, 2021,43(26):3839-3844. DOI: 10.1080/09638288.2020.1754927.
[24] Reis NFD, Biscaro RRM, Figueiredo FCXS, et al. Early rehabilitation index: translation and cross-cultural adaptation to brazilian portuguese; and early rehabilitation barthel index: validation for use in the intensive care unit[J]. Rev Bras Ter Intensiva, 2021, 33(3):353–61. DOI: 10.5935/0103-507X.20210051.
[25] Hwang J, Hadeed M, Sapp T, et al. Varus displacement of intertrochanteric femur fractures on injury radiographs is associated with screw cutout[J]. Eur J Orthop Surg Traumatol, 2021, 31(4):683-687. DOI: 10.1007/s00590-020-02820-1.
[26] Tazawa R, Minehara H, Matsuura T, et al. Biomechanical evaluation of internal fixation for the treatment of comminuted subtrochanteric femur fractures[J]. J Orthop Sci, 2021,26(2):261-265. DOI: 10.1016/j.jos.2020.03.002.
[27] Morgan P. What's new in hip replacement[J]. J Bone Joint Surg Am, 2021,103(18):1667-1674. DOI: 10.2106/JBJS.21.00612.
[28] Kay J, Memon M, Lindner D, et al. Arthroscopic management of greater trochanter pain syndrome and abductor tears has demonstrated promising results in terms of improvement in pain scores and functional outcomes: a scoping review[J]. Knee Surg Sports Traumatol Arthrosc, 2021,29(8):2401-2407. DOI: 10.1007/s00167-020-06322-9.