不同剂量右美托咪定联合舒芬太尼对老年股骨粗隆间骨折手术患者术后认知功能的影响

蔄莲萍; 许芳芳; 董梅

doi:10.20053/j.issn1001-5094.202503030080

不同剂量右美托咪定联合舒芬太尼对老年股骨粗隆间骨折手术患者术后认知功能的影响

Impact of Different Doses of Dexmedetomidine Combined with Sufentanil on Postoperative Cognitive Function in Elderly Patients Undergoing Surgery for Trochanteric Fractures of the Femur

摘要

摘要: 目的评估右美托咪定-舒芬太尼复合麻醉在老年股骨粗隆间骨折手术中的剂量效应及其对患者术后认知功能的影响。方法按随机数字表法将山东省文登整骨医院2022年10月至2023年12月收治的267例老年股骨粗隆间骨折患者分为A组、B组和C组，每组89例，分别接受不同剂量右美托咪定(0.25、0.50和1.00μg·kg^-1)联合舒芬太尼进行麻醉。比较各组的镇痛效果、炎症指标、认知功能及不良反应。结果 3组的术后视觉模拟评分法（visual analogue scale,VAS）评分呈先上升后下降趋势，于12 h达峰值，组内各时间点比较存在统计学差异（双侧P <0.05）;3组在术后2、6和12 h时的VAS评分比较结果为A组> B组> C组（单侧P <0.025）；术后24 h时VAS评分组间无统计学差异（双侧P> 0.05）。3组在术后48 h的C反应蛋白（C-reactive protein,CRP）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）及白介素-10（interleukin-10,IL-10）水平较术前增高（单侧P <0.025）;3组在术后48 h的CRP、TNF-α及IL-10水平比较结果为A组> B组> C组（单侧P <0.025）。3组在术后24和72 h的蒙特利尔认知评估量表（Montreal cognitive assessment scale,MoCA）和简易精神状态检查表（Mini-Mental State Examination,MMSE）评分较术前有所降低（单侧P <0.025），但C组术后各时间点的MoCA评分和MMSE评分高于A组、B组，A组最低（单侧P <0.025）。C组不良反应总发生率明显高于A组与B组（双侧P <0.05）。结论 1.0μg·kg^-1右美托咪定联合舒芬太尼可有效缓解老年股骨粗隆间骨折手术患者术后疼痛，减轻炎症反应，改善认知功能。但考虑到术后不良反应发生情况，0.50μg·kg^-1右美托咪定更为安全。

Abstract: Objective To evaluate the dose-response relationship of dexmedetomidine-sufentanil combined anesthesia in elderly patients undergoing surgery for trochanteric fractures of the femur and its impact on postoperative cognitive function. Methods Using a random number table, 267 elderly patients with trochanteric fractures of the femur admitted to Shandong Wendeng Osteopathic Hospital from October 2022 to December 2023 were divided into Group A, B, and C, with 89 patients in each group. Each group respectively received anesthesia with different doses of dexmedetomidine(0.25, 0.50 and 1.00 μg·kg^-1) combined with sufentanil. The analgesic effects, inflammatory indicators, cognitive function, and adverse reactions were compared among the groups. Results The postoperative visual analogue scale（VAS） scores in all three groups showed a trend of an initial increase followed by a decrease, peaking at 12 h after surgery. There were statistically significant differences among the time points within each group（two-sided P ＜ 0.05）. At 2, 6 and 12 h after surgery, the VAS scores were Group A ＞ Group B ＞ Group C（one-sided P ＜ 0.025）. At 24 h after surgery, there were no statistically significant differences in VAS scores among the groups（two-sided P ＜ 0.05）. At 48 h after surgery, the levels of C-reactive protein（CRP）, tumor necrosis factor-α（TNF-α）, and interleukin-10（IL-10） in all three groups were higher than preoperative levels（one-sided P＜0.025）. The comparison of CRP, TNF-α and IL-10 levels at 48 h after surgery among three groups showed that Group A ＞ Group B ＞ Group C（one-sided P ＜ 0.025）. The scores of the Montreal cognitive assessment scale（MoCA） and mini-mental state examination（MMSE） at 24 and 72 h after surgery were lower than those before surgery in all three groups（one-sided P ＜ 0.025）. But the MoCA and MMSE scores at all time point after surgery in Group C were higher than those in Groups A and B, with Group A having the lowest scores（one-sided P＜0.025）. The overall incidence of adverse reactions in Group C was significantly higher than that in Group A and B（two-sided P＜0.05）. Conclusion Dexmedetomidine 1.0 μg·kg^-1 combined with sufentanil effectively alleviates postoperative pain, reduces inflammatory responses, and improves cognitive function in elderly patients with trochanteric fracture of the femur. However, considering the incidence of adverse events postoperatively, dexmedetomidine 0.50 μg·kg^-1 is safer.

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