探究不同浓度右美托咪定联合瑞芬太尼辅助局部浸润麻醉对老年腹股沟疝开放修补术患者的镇静作用及安全性。

2019年1至10月于重庆医科大学附属永川医院行局部浸润麻醉下腹股沟疝修补术治疗的90例老年腹股沟疝患者。通过随机数字表法将其分为对照组（45例）和观察组（45例）。对照组予以高剂量[0.6 μg/(kg·h）]盐酸右美托咪定注射液联合注射用盐酸瑞芬太尼辅助局部浸润麻醉；观察组予以低剂量[0.3μg/(kg·h）]盐酸右美托咪定注射液联合注射用盐酸瑞芬太尼辅助局部浸润麻醉。比较2组患者用药前（T1）、用药后10 min（T2）、20 min（T3）、30 min（T4）、患者清醒后（T5）的警觉/镇静（OAA/S）评分和血流动力学指标；观察2组局麻时、切皮时、手术中、缝皮时的疼痛程度及治疗期间的安全性。

T1～T4 2组OAA/S评分呈降低趋势，T5时OAA/S评分升高，差异有统计学意义（P<0.05）；T1～T4观察组平均动脉压（MAP）、心率（HR）呈降低趋势，T5时MAP、HR升高，差异有统计学意义（P<0.05）；且T3、T4时，观察组OAA/S评分、MAP、HR低于对照组，差异有统计学意义（P<0.05）。观察组在各时间点（局麻时、切皮时、手术中、缝皮时）的视觉模拟评分（VAS）均低于对照组，差异有统计学意义（P<0.05）。观察组患者躁动、恶性呕吐的发生率为2.22%、4.44%，低于对照组的17.78%、17.78%，差异有统计学意义（P<0.05）。

低剂量右美托咪定联合瑞芬太尼辅助局部浸润麻醉可显著改善老年腹股沟疝患者的血流动力学，镇静、镇痛效果显著，安全性高。

To investigate the sedative effect and safety of different concentrations of dexmedetomidine combined with remifentanil assisted local infiltration anesthesia for inguinal hernia repair in elderly patients.

Between January 2019 and October 2019, ninty elderly inguinal hernia patients undergoing laparoscopic inguinal hernia repair under local infiltration anesthesia in Chongqing Yongchuan children's hospital were randomly divided into the control group (n=45 cases) and the observation group (n=45 cases). The control group was given high dose [0.6μg/(kg·h)]) dexmedetomidine hydrochloride injection combined with remifentanil hydrochloride for injection to assist local infiltration anesthesia. The observation group was given low dose [0.3μg/ (kg·h)] dexmedetomidine hydrochloride injection combined with remifentanil hydrochloride for injection to assist local infiltration anesthesia. The alert/sedation (OAA/S) scores and hemodynamic indexes of the two groups before (T1), 10 min after medication (T2), 20 min after medication (T3), 30 min after medication (T4) and patients after waking (T5) were compared. The pain degree during local anesthesia, skin incision, operation and skin suture and the safety during treatment were observed.

The OAA/S scores in the two groups showed a decreasing trend at T1-T4, and increased at T5 (P<0.05). The mean arterial pressure (MAP) and heart rate (HR) in the observation group showed a decreasing trend at T1-T4, while MAP and HR increased at T5 (P<0.05). At T3 and T4, OAA/S scores, MAP and HR in the observation group were lower than those in the control group (P<0.05). The visual analogue scale (VAS) score in the observation group was lower than that in the control group at all time points (local anesthesia, skin incision, surgery and skin suture) (P<0.05). The incidence rates of agitation and malignant vomiting in the observation group were 2.22% and 4.44%, which were lower than those in the control group (17.78% and 17.78%, P<0.05).

Low dose dexmedetomidine combined with remifentanil assisted local infiltration anesthesia can significantly improve the hemodynamics of elderly patients with inguinal hernia, with significant sedative and analgesic effects and high safety, and it is worthy of promotion.