摘要
目的探讨不同剂量右美托咪定对意外创伤手术患者应激障碍的影响。方法对2016年6月—2019年6月该院收治的因交通意外下肢骨折需行骨折复位内固定手术的84例患者的临床资料进行回顾性分析,根据资料中的麻醉方式将研究对象分为对照组(n=28)、右美托咪定低剂量组(n=28)、右美托咪定高剂量组(n=28)。所有患者均采用硬膜外注射罗哌卡因+利多卡因麻醉,硬膜外麻醉成功后低剂量组与高剂量组分别给予0.5μg/kg、1.0μg/kg右美托咪定,对照组给予等容量生理盐水。观察记录患者术后48h镇痛补救率与术后3个月急性创伤应激障碍发生率;并比较各组患者术前1h与术后1d、3d、7d急性应激障碍量表(ASDS)、焦虑自评表(SAS)、抑郁自评表(SDS)的评分情况。结果三组术后创伤后应激障碍发生率差异有统计学意义,且高剂量组创伤后应激障碍发生率明显低于低剂量组与对照组(均P<0.05);术后1d、3d、7d,高剂量组ASDS评分均低于低剂量组和对照组(均P<0.05);术后1d、3d、7d,高剂量组与低剂量组SAS、SDS评分均低于对照组(均P<0.05),但高剂量组与低剂量组比较差异无统计学意义(P>0.05)。结论意外创伤手术患者使用的高剂量右美托咪定对于降低患者术后应激障碍发生率明显优于低剂量,同时能够更有效地缓解患者焦虑、抑郁症状。
Objective To investigate the effect of different doses of dexmedetomidine on stress disorder in patients undergoing trauma surgery.Methods From June 2016 to June 2019,the clinical data of eighty four patients with lower limb fracture due to traffic accident who needs fracture reduction and internal fixation in 922 Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army were analyzed retrospectively.According to the anesthesia methods in the data,they were randomly divided into control group(n=28),Dexmedetomidine low dose group(n=28),Dexmedetomidine high dose group(n=28).All patients were anesthetized by epidural injection of ropivacaine and lidocaine.After the success of epidural anesthesia,the low-dose group and the high-dose group were given 0.5 μg/kg and 1.0 μg/kg dexmedetomidine respectively.The control group was given normal saline of equal volume.The recovery rate of analgesia 48 h after operation and the incidence rate of acute traumatic stress disorder 3 months after operation were observed and compared.The scores of ASDS,SAS and SDS of patients in each group were analyzed and compared.Results The incidence of PTSD in the three groups was significantly different,and the incidence of PTSD in the high-dose group was significantly lower than those in the low-dose group and the control group(P<0.05).The ASDS scores in the high-dose group were significantly lower than those in the low-dose group and the control group(P<0.05) at 1 d,3 d and 7 d after operation.The SAS and SDS scores of high dose group and low dose group were significantly lower than those of control group(P<0.05),but there was no significant difference between high dose group and low dose group(P>0.05).Conclusion High dose dexmedetomidine is better thanlow-dose dexmedetomidine in reducing postoperative stress disorder,and it can more effectively relieve anxiety and depression symptoms of patients.
作者
洪勇
肖振涛
周民伟
刘建忠
Hong Yong;Xiao Zhentao;Zhou Minwei(Department of Anesthesiolo-gy,922 Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Ar my,Hengyang 421002,China)
出处
《中国煤炭工业医学杂志》
2020年第6期649-653,共5页
Chinese Journal of Coal Industry Medicine
基金
湖南省卫生计生委科研项目(编号:B2016151)。
关键词
右美托咪定
意外创伤
应激障碍
焦虑
抑郁
Dexmedetomidine
Accidental injury
Stress disorder
Anxiety and depression
