摘要
目的探讨阿芬太尼联合右美托咪定在老年患者椎体成形术监护麻醉(MAC)中的安全性、有效性及对术后认知功能的影响。方法选取2024年1月至2025年2月广东医科大学附属东莞松山湖中心医院骨科收治的126例拟行椎体成形术的老年患者作为研究对象,按照随机数字表法分为SF-DEX组(舒芬太尼联合右美托咪定组)和AF-DEX组(阿芬太尼联合右美托咪定组),每组63例。监测两组患者术中血流动力学[平均动脉压(MAP)、心率(HR)]、血氧饱和度(SPO_(2))、呼吸频率(RR)、镇静深度(NT)和视觉模拟评分法(VAS)评分,记录两组患者术后苏醒时间、认知功能[简易精神状态检查量表(MMSE)评分]及不良反应。结果AF-DEX组T_(1)时的MAP和HR均高于SF-DEX组,T_(2)时的MAP和HR均低于SF-DEX组,差异有统计学意义(P<0.05)。AF-DEX组T_(1)、T_(2)时的VAS评分低于SF-DEX组,差异有统计学意义(P<0.05)。AF-DEX组呼吸抑制、低氧血症、恶心呕吐发生率低于SF-DEX组,术后苏醒时间短于SF-DEX组,差异有统计学意义(P<0.05)。两组患者头晕发生率比较,差异无统计学意义(P>0.05)。术后24 h,AF-DEX组MMSE评分高于SF-DEX组,差异有统计学意义(P<0.05)。AF-DEX组谵妄发生率低于SF-DEX组,差异有统计学意义(P<0.05)。结论阿芬太尼联合右美托咪定方案可优化老年椎体成形术MAC质量,维持血流动力学稳定,减少呼吸安全性事件及优化围手术期效率,同时改善术后早期认知功能。
Objective To explore the safety,efficacy and influence on postoperative cognitive function of Alfentanil combined with Dexmedetomidine in monitored anesthesia care(MAC)for vertebroplasty in elderly patients.Methods A total of 126 elderly patients scheduled for vertebroplasty who were admitted to the Department of Orthopedics of Dongguan Songshan Lake Center Hospital Affiliated to Guangdong Medical University from January 2024 to February 2025 were selected as the research objects,they were divided into the SF-DEX group(Sufentanil combined with Dexmedetomidine group)and the AF-DEX group(Alfentanil combined with Dexmedetomidine group)according to the random number table method,with 63 cases in each group.The intraoperative hemodynamics(mean arterial pressure[MAP],heart rate[HR]),oxygen saturation(SPO_(2)),respiratory rate(RR),narcotrend(NT),and visual analogue scale(VAS)scores of the two groups of patients were monitored.The postoperative recovery time,cognitive function(mini-mental state examination[MMSE]score)and adverse reactions of the two groups of patients were recorded.Results The MAP and HR of the AF-DEX group at T_(1) were both higher than those of the SF-DEX group,while those at T_(2) were both lower than those of the SF-DEX group,the differences were statistically significant(P<0.05).The VAS scores of the AF-DEX group at T_(1) and T_(2) were lower than those of the SF-DEX group,and the differences were statistically significant(P<0.05).The incidences of respiratory depression,hypoxemia,nausea and vomiting in the AF-DEX group were lower than those in the SF-DEX group,and the postoperative recovery time was shorter than that in the SF-DEX group,the differences were statistically significant(P<0.05).There was no statistically significant difference in the incidence of dizziness between the two groups of patients(P>0.05).At 24 hours after the operation,the MMSE score of the AF-DEX group was higher than that of the SF-DEX group,and the difference was statistically significant(P<0.05).The incidence of delirium in the AF-DEX group was lower than that in the SF-DEX group,and the difference was statistically significant(P<0.05).Conclusion The Alfentanil combined with Dexmedetomidine regimen can optimize the MAC quality of vertebroplasty in the elderly,maintain hemodynamic stability,reduce respiratory safety events and optimize perioperative efficiency,while improving early postoperative cognitive function.
作者
王冬红
陈妙婷
周宝兰
何红霞
李再学
全守波
WANG Donghong;CHEN Miaoting;ZHOU Baolan;HE Hongxia;LI Zaixue;QUAN Shoubo(Department of Anesthesiology,Dongguan Songshan Lake Center Hospital Affiliated to Guangdong Medical University,Guangdong Province,Dongguan 523000,China;Department of Orthopedics,Dongguan Songshan Lake Center Hospital Affiliated to Guangdong Medical University,Guangdong Province,Dongguan 523000,China)
出处
《中国当代医药》
2025年第25期95-99,共5页
China Modern Medicine
基金
北京康盟慈善基金会卫生健康发展促进项目-麻醉与重症科研项目(KM-20231018-01)。
关键词
阿芬太尼
右美托咪定
椎体成形术
监护麻醉
老年患者
Alfentanil
Dexmedetomidine
Vertebroplasty
Monitored anesthesia care
Elderly patient
