右美托咪啶对青少年特发性脊柱侧弯矫形术后谵妄的影响

Effects of Dexmedetomidine on the Postoperative Delirium in Adolescent Idiopathic Scoliosis Undergoing Spine Surgery

目的观察右美托咪啶对青少年特发性脊柱侧弯矫形术后谵妄的影响．方法选择青少年特发性脊柱侧弯患者160例，年龄7～16岁，ASAⅡ-Ⅲ，麻醉诱导插管后随机分为2组（n=80），SS组：舒芬太尼0．2μg/（kg·h）泵注，呼气末七氟醚靶浓度1％-2％吸入维持麻醉；SSD组：舒芬太尼0．2μg／（kg·h）泵注，呼气末七氟醚靶浓度1％～2％吸入，右美托咪啶0．2μg／h泵注维持麻醉，调整七氟醚靶浓度维持BIS值40。60，应用血管活性药维持MAP65—75mmHg．术毕记录手术时间、术中出血量、输血量、七氟醚用量、舒芬太尼用量、右美托咪啶用量、呼吸恢复时间、麻醉恢复时间、清醒时间、术后2h内躁动发生情况及术后3d谵妄发生情况．结果2组患者手术时间、术中出血量、输血量、舒芬太尼用量、呼吸恢复时间、麻醉恢复时间、清醒时间差异无统计学意义，SS组七氟醚用量明显多于SSD组（P〈0．05），术后2h内躁动发生率及术后3d谵妄发生率也明显高于SSD组．结论术中辅助应用右美托咪啶0．2μg／h可减少青少年特发性脊柱侧弯术后谵妄的发生．

Objective To investigate the effect of dexcedetomidine on the postoperative delirium in adolescent idiopathic scoliosis undergoing spine surgery. Methods 160 patients （7-16 years of age） with idiopathic scoliosis undergoing posterior spinal fusion were randomly divided in to two groups. Group SS （n = 80） included patients anesthetized with sevorane and sufentanil, group SSD （n =80） included patients anesthetized with sevorane, sufentanil and dexcedetomidine. In the latter group, dexcedetomidine was administered as a continuous infusion of 0.2 ug/h started after the induction of anesthesia without a loading dose. Sevorane was adjusted to maintain the bispectral index （BIS） number at 40-60 and vasoactive drugs was adjusted to maintain the mean arterial pressure （MAP） at 65-75 mmHg. The amount of anesthetic, the time of anesthesia recovery, restlessness during recovery and postoperative delirium were recorded. Results The amount of sevorane, the incidence of restlessness during recovery and the incidence of postoperative delirium were significantly lower in the group SSD than in group SS （P〈0.05） . Conclusion The perioperative infusion of 0.2 ug/h dexcedetomidine can decrease the incidence of postoperative delirium in adolescent idiopathic seoliosis undergoing spine surgery.