CAJ | 학술논문

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。
목적：탐토분태니급우미탁미정재노년하지골절환자술후자공정맥진통（PCIA）적림상효과。방법장본원골과수치적84례노년하지골절절개복위내고정치료적환자수궤분위관찰조화대조조，매조각42례。관찰조환자채용우미탁미정진행술후PCIA，대조조환자채용분태니진행술후PCIA，비교량조환자술전、술후1、4、8、12、24、48소시적수축압（SBP）、서장압（DBP）、평균동맥압（MAP）、심솔（HR）변화정황급상술불동시간점적시각모의평분법（VAS）평분、PCIA안건차수급불량반응발생정황。결과관찰조환자술전、술후1、4、8、12、24、48소시SBP、DBP、MAP、HR비교차이무현저성；대조조환자부HR재술후1、4、8소시교치료전현저승고（P＜0.05），SBP、DBP급MAP여술전비교차이무현저성；술후1、4、8소시대조조환자HR고우관찰조（P＜0.05），기여지표조간비교차이무현저성。술후1、4、8、12、24관찰조환자VAS평분균현저저우대조조，차이균구유현저성（P＜0.05）；단술후48소시량조환자VAS평분비교차이무현저성。관찰조환자PCIA안건평균차수급불량반응발생솔균현저저우대조조（P＜0.05）。결론노년하지골절환자여이절개복위내고정치료후，채용우미탁미정진행술후PCIA적림상효과현저우우분태니，불량반응소，치득림상추엄응용。
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 ifxation 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. Result The differences in comparisons of SBP, DBP, MAP and HR of patients in observation group before and after treatment were not statistically signiifcant. Only HR of patients signiifcantly 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 signiifcant 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 signiifcant differences between the two groups (P > 0.05). VAS scores in observation group were signiifcantly 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 signiifcant 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 ifxation, less adverse reactions occur, worthy of popularization and application in clinical practices.