摘要
目的下肢骨折是临床常见创伤类型,部分患者需要在全身麻醉下进行手术治疗,但术后麻醉相关不良反应较多。本研究分析气管插管后静脉应用右美托咪定(dexmedetomidine,DEX)对下肢骨折患者术后苏醒质量及细胞免疫功能影响。方法选取2016-10-12-2019-10-12河南省洛阳正骨医院行手术治疗的142例下肢骨折患者为研究对象,按照组间基本特征均衡的原则分为DEX组和常规组,各71例,均在常规全身麻醉下完成手术,其中DEX组在气管插管后加用DEX,比较两组术后疼痛评分、苏醒质量、细胞免疫功能及不良反应发生率。结果DEX组术后3h(t=2.348,P=0.001)、6h(t=2.995,P=0.003)、12h(t=3.467,P=0.001)和24h(t=2.351,P=0.020)视觉模拟疼痛评分均低于常规组。DEX组24h内患者自控静脉镇痛次数为(12.64±3.19)次,低于常规组的(14.08±3.27)次,t=2.656,P=0.009。DEX组术后躁动程度评分为(0.64±0.21)分,低于常规组的(0.81±0.27)分,t=4.118,P<0.001。DEX组术后Ramsay镇静评分为(2.39±0.58)分,高于常规组的(2.03±0.52)分,t=3.894,P<0.001。DEX组术后3dCD3+占比为(56.83±7.25)%,高于常规组的(54.08±7.53)%,t=2.217,P=0.028;CD4+占比为(32.96±5.71)%,高于常规组的(30.25±5.84)%,t=2.796,P=0.006;CD4+/CD8+为1.18±0.24,高于常规组的1.07±0.23,t=2.788,P=0.006。DEX组不良反应发生率为11.27%,低于常规组的23.94%,χ2=3.932,P=0.047。结论全身麻醉下肢骨折患者气管插管后应用DEX可有效提升术后镇痛效果,改善苏醒质量,减轻细胞免疫功能抑制并减少不良反应。
OBJECTIVE Lower limb fractures are a common type of clinical trauma.Some patients require surgical treatment under general anesthesia,but there are many adverse reactions related to postoperative anesthesia.This study analyzed the intravenous application of dexmedetomidine(DEX)to the lower limbs after tracheal intubation,effects of postoperative recovery quality and cellular immune function in fracture patients.METHODS A total of 142 patients with lower limb fractures who underwent surgical treatment in Luoyang Orthopedic Hospital of Henan Province from October12,2016 to October 12,2019 were selected as the research objects.They were divided into the DEX group and the routine group according to the principle of balance between the basic characteristics of the groups,each with 71 cases.All cases were performed under conventional general anesthesia.DEX was added to the DEX group after tracheal intubation.The postoperative pain score,recovery quality,cellular immune function and incidence of adverse reactions were compared between the two groups.RESULTS The visual analogue pain scores in the DEX group were lower than those of the conventional group at 3 h(t=2.348,P=0.001),6 h(t=2.995,P=0.003),12 h(t=3.467,P=0.001)and 24 h(t=2.351,P=0.020)after surgery.The number of patient-controlled intravenous analgesia in the DEX group within 24 hours was(12.64±3.19)times,which was lower than that of the conventional group(14.08±3.27)times,t=2.656,P=0.009.The postoperative restlessness score in the DEX group was 0.64±0.21,which was lower than that of the conventional group 0.81±0.27,t=4.118,P<0.001.The postoperative Ramsay sedation score in the DEX group was 2.39±0.58,which was higher than that of the conventional group 2.03±0.52,t=3.894,P<0.001.The proportion of CD3+in the DEX group at 3 days postoperatively was(56.83±7.25)%,which was higher than that of the conventional group(54.08±7.53)%,t=2.217,P=0.028.The proportion of CD4+was(32.96±5.71)%,which was higher than that of the conventional group(30.25±5.84)%,t=2.796,P=
作者
赵彦春
陈丽华
ZHAO Yan-chun;CHEN Li-hua(Department of Anesthesiology,Luoyang Orthopedic Hospital of Henan Province·Henan Orthopedic Hospital,Luoyang 471000,P.R.China)
出处
《社区医学杂志》
CAS
2020年第24期1656-1659,共4页
Journal Of Community Medicine
关键词
下肢骨折
气管插管
右美托咪定
苏醒质量
细胞免疫
lower limb fractures
tracheal intubation
dexmedetomidine
recovery quality
cellular immunity
