右美托咪定预防非心脏手术高龄患者术后谵妄的给药时机和剂量研究

Study on the Timing and Dosage of Dexmedetomidine for Preventing Postoperative Delirium in Elderly Patients Undergoing Non-cardiac Surgery

目的研究右美托咪定(dexmedetomidine,Dex)预防非心脏手术高龄患者术后谵妄(postoperative delirium,POD)的给药时机和剂量。方法选取2020年5月—2022年5月在深圳市前海蛇口自贸区医院进行择期非心脏手术的患者500例为研究对象,按随机数表法分成A、B、C、D、E组5组,每组100例,5组应用Dex通过不同剂量及给药时机,比较5组POD的发生率、MMSE评分以及围术期不良反应发生率。结果A组POD的发生率(4.00%)均较其他各组明显更低,而E组发生率(36.00%)较其他各组明显更高,C组发生率(12.00%)较D组(23.00%)更低,差异有统计学意义(P<0.05)。T1~T3时,A组MMSE评分较其他各组均更高,而B、C组分别较D、E组均更高,D组较E组更高,差异有统计学意义(P<0.05)。T2、T3时,A、E组MMSE评分分别较T0、T1时更低,T3时评分较T2时更低,差异有统计学意义(P<0.05);T1时,E组MMSE评分较T0时更低,差异有统计学意义(P<0.05)。5组围术期不良反应发生率比较,差异无统计学意义(P>0.05)。结论小剂量的Dex应用至术毕方案能够有效预防非心脏手术的高龄患者POD形成,且能改善患者的认知功能,安全性较好。

Objective To study the timing and dosage of dexmedetomidine(Dex)to prevent postoperative delirium(POD)in elderly patients undergoing non-cardiac surgery.Methods 500 patients who underwent elective non cardiac surgery at Qianhai Shekou Free Trade Zone Hospital in Shenzhen from May 2020 to May 2022 were selected as the research subjects.They were randomly divided into five groups:A,B,C,D,and E,with 100 patients in each group.The incidence of POD,MMSE scores,and perioperative adverse reactions in the five groups were compared using Dex at different doses and administration times.Results The incidence of POD in group A(4.00%)was significantly lower than other groups,while the incidence in group E(36.00%)was significantly higher than other groups,the incidence in group C(12.00%)was lower than that in group D(23.00%),and the difference was statistically significant(P<0.05).At T1~T3,the MMSE score of group A was higher than that of other groups,while group B and C were higher than group D and E,and group D was higher than group E,the difference was statistically significant(P<0.05).At T2 and T3,the MMSE scores of group A and group E were lower than those at T0 and T1,and the scores at T3 were lower than those at T2,the difference was statistically significant(P<0.05).At T1,the MMSE score of group E was lower than at T0,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of perioperative adverse reactions among the 5 groups(P>0.05).Conclusion The application of lowdose Dex to the end of surgery can effectively prevent the formation of POD in elderly patients undergoing non cardiac surgery,and can improve the patient's cognitive function with good safety.