| ObjectiveThe effect of dexmedetomidine and butorfenol on the stress response during extubation was observed when used for general anesthesia for hip arthroplasty,so as to improve the quality of wakefulness in patients undergoing hip arthroplasty and provide a reference for the clinical application of the two drugs.MethodsFrom November 2021 to November 2022,90 patients aged 45-75 years,with ASA grade I.-II.,and elective hip arthroplasty were selected as the research subjects,and divided into three groups according to the random number table method,30 cases in D group(dexmedetomidine group),with an administration dose of 0.3μg/kg,and a constant rate intravenous pump for 10 minutes 40 minutes before the end of the operation;There were 30 patients in group B(butorphanol group),the dose was 15μg/kg,and the intravenous pump was constant rate for 10 minutes 40 minutes before the end of the operation;In group C(dexmedetomidine + butorphanol group),there were 30 cases,the dose of dexmedetomidine was 0.3 μg/kg,the dose of butorfenol was15 μg/kg,and the intravenous pump at constant rate was given for 10 minutes 40 minutes before the end of the operation.The heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(Sp O2)before anesthesia induction(T0),at the end of surgery(T1),at extubation(T2),5 min(T3)after extubation and 30 min(T4)after extubation were observed and recorded in three groups.Visual analogue score(VAS)at T3,T4 and 2 hours postoperative(T5);Ricker sedation-agitation score(SAS)at T2,T3,T4,and T5;choking response score at T2;and adverse reactions within 24 hours after extubation.Results1.A total of 90 patients were included in the statistical analysis.There was no significant difference in general data between the three groups(P>0.05).2.The overall comparison difference between the three groups at each time was statistically significant(P<0.05).Compared with T0,the HR of the D group at the T1-T4 moment was reduced(P<0.05),and compared with T1,the HR at the T2-T4 moment was increased in the D group(P<0.05).Compared with T0,the HR of group B at the time of T1 decreased(P<0.05),and compared with T1,the HR of the T2-T4 moment of group B was increased to varying degrees(P<0.05).Compared with T0,HR decreased in T1-T4 moments in group C(P<0.05),and in T1 group decreased in all times T2-T4(P<0.05).Compared with the three groups at different times,there were significant differences in HR at T1-T4(P<0.05).Compared with group D,there was a significant difference in HR in group B at the time of T2-T4(P<0.05),and there was a significant difference in HR in group C at the time of T1-T4(P<0.05),and compared with group B,the difference in HR in group C at the time of T1-T4 was statistically significant(P<0.05).3.The overall comparison difference between the three groups at each moment was statistically significant(P<0.05).Compared with T0,MAP decreased at T1(P<0.05)and increased at T2(P<0.05),compared with T1,MAP in T2-T4 increased(P<0.05),and compared with T2,MAP in T3(P<0.05)decreased in group D.Compared with T0 and T1,the MAP of T2-T4 was increased in group B(P<0.05),and compared with T2,the MAP of T3 and T4 in group B was reduced(P<0.05).Compared with T0,the MAP of T1-T4 decreased in group C(P<0.05)and compared with T1,the MAP of T2-T4 in group C increased(P<0.05).Compared with the three groups at different moments,there were significant differences in MAP at T1-T4(P<0.05).Compared with group D,there was a significant difference between MAP at T1-T4 and 0<.05 in group C,and there were different significant differences in MAP in group C at T1 and T2(P<0.05),and compared with group B,there was a significant difference in MAP at T1-T4(P<0.05).4.There was no significant difference in Sp O2 levels between the three groups in each time period(P>0.05).5.At T3,T4 and T5,the VAS scores of patients in group C decreased significantly compared with those in group D and group B,and the VAS scores of patients in group B were also lower than those in group D,and the difference was statistically significant(P<0.05).6.At T2,T3 and T4,compared with group D and group B,group C had the lowest SAS score,and the difference was statistically significant(P<0.05).Compared with group B,although the SAS scores of patients in group D were slightly lower at T2,T3 and T4,the difference was not statistically significant(P>0.05).At T5,there was no significant difference in SAS scores between the three groups(P>0.05).7.Compared with group C,the choking response score level of group D and group B at extubation was significantly increased,and the difference was statistically significant(P<0.05).The choking response score of patients in group D at extubation was higher than that in group B,and the difference was statistically significant(P<0.05).8.One patient in group D had hypotension,and the incidence of adverse reactions was 3.33%;Among the patients in group B,2 patients developed respiratory depression and 1 had chills,and the incidence of adverse reactions was 10%;Among the patients in group C,2 patients developed respiratory depression,1 had hypotension,and 1 had chills,and the incidence of adverse reactions was 13.33%.There was no significant difference in the incidence of adverse reactions between the three groups within 24 hours after extubation(P>0.05).Conclusions1.Compared with butorphanol,dexmedetomidine before the end of surgery in hip replacement patients undergoing general anesthesia contributes to hemodynamic stability during extubation and is less effective in suppressing the choking response and relieving postoperative pain.2.Compared with the use of dexmedetomidine or butorphanol alone,the use of dexmedetomidine combined with butorphanol before the end of the operation in patients undergoing hip replacement under general anesthesia can better maintain the stability of hemodynamics during extubation,reduce the occurrence of restlessness and coughing reactions during extubation,which is more conducive to maintaining the sedative and analgesic effect in the awakening period and alleviating the stress response of patients. |
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