右美托咪定联合舒芬太尼对老年下肢骨折手术患者术后镇痛效果、应激反应和认知功能的影响

摘要 目的：探讨舒芬太尼联合右美托咪定在老年下肢骨折术后镇痛中的效果及对术后应激反应和认知功能的影响。方法：选取我院2017年4月~2021年12月期间收治的老年下肢骨折手术患者80例，根据随机数字表法分为对照组和研究组，各为40例。对照组术后镇痛予以舒芬太尼，研究组术后镇痛予以右美托咪定联合舒芬太尼，观察两组镇静镇痛效果，并观察镇痛方案对患者血流动力学、术后应激反应和认知功能的影响，记录两组不良反应情况。结果：研究组术后8 h（T1）~术后16 h（T2）时间点平均动脉压（MAP）、心率（HR）低于对照组（P<0.05）。研究组T1~术后24 h（T3）时间点视觉模拟评分法（VAS）评分低于对照组，Ramsay 镇静评分高于对照组（P<0.05）。研究组T3时间点去甲肾上腺素（NE）、肾上腺素（E） 、皮质醇（Cor）水平低于对照组（P<0.05）。研究组的术后认知功能障碍（POCD）发生率低于对照组（P<0.05）。研究组T1、T3时间点简易精神状态量表（MMSE）评分高于对照组（P<0.05）。两组的不良反应发生率对比无差异（P>0.05）。结论：右美托咪定联合舒芬太尼应用于老年下肢骨折术后患者，镇痛镇静效果确切，可减轻术后应激反应，降低POCD发生率。

Effects of Dexmedetomidine Combined with Sufentanil on Postoperative Analgesia, Stress Response and Cognitive Function in Elderly Patients with Lower Limb Fracture Surgery

ABSTRACT Objective: To investigate the effect of dexmedetomidine combined with sufentanil on postoperative analgesia and postoperative stress response and cognitive function in elderly patients with lower limb fracture surgery. Methods: The data of 80 elderly patients with lower limb fracture in our hospital from April 2017 to December 2021 were selected, and they were randomly divided into control group and study group by the table of random numbers, 40 cases in each group. The control group was given sufentanil for postoperative analgesia, and the study group was given dexmedetomidine combined with sufentanil for postoperative analgesia. The sedative and analgesic effects of the two groups were observed, and the effects of analgesia regimen on hemodynamics, postoperative stress response and cognitive function were observed, and the adverse reactions of the two groups were recorded. Results: The mean arterial pressure (MAP) and heart rate (HR) of the study group at 8 h after operation (T1) to 16 h after operation (T2) were lower than those of the control group (P<0.05). The visual analogue scale (VAS) score of the study group at T1-24 h after operation (T3) was lower than that of the control group, and the Ramsay sedation score was higher than that of the control group(P<0.05). The levels of norepinephrine (NE), epinephrine (E) and cortisol (Cor) of the study group at T3 time point were lower than those of the control group (P<0.05). The incidence of postoperative cognitive dysfunction (POCD) of the study group was lower than that of the control group(P<0.05). The mini-mental state examination (MMSE) score of the study group at T1 and T3 time point were higher than those of the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Dexmedetomidine combined with sufentanil in elderly patients with lower limb fracture after operation has definite analgesic and sedative effect, can reduce postoperative stress response, and reduce the incidence of POCD.