摘要
目的探讨芬太尼及右美托咪定在老年下肢骨折患者术后自控静脉镇痛(PCIA)的临床效果。方法将本院骨科收治的84例老年下肢骨折切开复位内固定治疗的患者随机分为观察组和对照组,每组各42例。观察组患者采用右美托咪定进行术后PCIA,对照组患者采用芬太尼进行术后PCIA,比较两组患者术前、术后1、4、8、12、24、48小时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)变化情况及上述不同时间点的视觉模拟评分法(VAS)评分、PCIA按键次数及不良反应发生情况。结果观察组患者术前、术后1、4、8、12、24、48小时SBP、DBP、MAP、HR比较差异无显著性;对照组患者仅HR在术后1、4、8小时较治疗前显著升高(P<0.05),SBP、DBP及MAP与术前比较差异无显著性;术后1、4、8小时对照组患者HR高于观察组(P<0.05),其余指标组间比较差异无显著性。术后1、4、8、12、24观察组患者VAS评分均显著低于对照组,差异均具有显著性(P<0.05);但术后48小时两组患者VAS评分比较差异无显著性。观察组患者PCIA按键平均次数及不良反应发生率均显著低于对照组(P<0.05)。结论老年下肢骨折患者予以切开复位内固定治疗后,采用右美托咪定进行术后PCIA的临床效果显著优于芬太尼,不良反应少,值得临床推广应用。
Objective To explore clinical effect of patients controlled intravenous analgesia（PCIA） implementation in elderly patients with lower limb fracture when fentanyl and dexmedetomidine were used. Method 84 patients with lower limbs fractures undergoing internal fixation of open reduction were randomly divided into observation group and control group with 42 cases in each group. Patients in observation group used dexmedetomidine for PCIA, and patients in control group used fentanyl, compared the changes in SBP, DBP, MAP and HR of patients at 1, 4, 8, 12, 24 and 48 hours and visual analogue scale（VAS） score at different times, keystrokes of PCIA and occurrences of adverse reactions before and after treatment. ResultThe differences in comparisons of SBP, DBP, MAP and HR of patients in observation group before and after treatment were not statistically significant. Only HR of patients significantly increased in 1, 4 and 8 hours when indexes of patients were compared those before treatment（P〈0.05）. Compared the differences between SBP, DBP and MAP with no significant preoperative. HR of patients in control group at 1, 4 and 8 hours were higher than that observation group（P〈0.05）. Other indexes had no significant differences between the twogroups（P〉0.05）. VAS scores in observation group were significantly lower than that of control group in 1, 4, 8, 12 and 24 hours（P〈0.05）, but 48 hours after operation two groups had no significant differences（P〉0.05）. The average frequency of regulation PCIA within 48 hours and the incidence of adverse reactions in observation group were obviously lower than that of control group（P〈0.05）. Conclusion Clinical effect of postoperative PCIA by using of dexmedetomidine is better than that of postoperative PCIA by using of fentanyl when elderly patients with lower limb fracture undergoing open reduction internal fixation, less adverse reactions occur, worthy of popularization and application in clinical practices.
出处
《中国医学前沿杂志（电子版）》
2014年第12期26-29,共4页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
老年
下肢骨折
芬太尼
右美托咪定
自控静脉镇痛
Elderly
Lower limb fracture
Fentanyl
Dexmedetomidine
Controlled intravenous analgesia
