右美托咪定对老年单侧膝关节置换术后谵妄发生率的影响

Effect of Dexmedetomidine combined anesthesia on postoperative delirium in elderly patients undergoing unilateral knee joint replacement surgery

目的 比较术中使用右美托咪定与丙泊酚对老年单侧膝关节置换术后谵妄发生率的影响。方法 选取2012年11月～2014年2月在北京积水潭医院行择期单侧膝关节置换术的老年患者进行前瞻性随机对照研究。所有患者均行神经刺激器定位股神经阻滞，给予0．4％罗哌卡因25mL后行连续股神经置管（CFNB）进行术后镇痛．术中使用静脉吸入复合全身麻醉。D组使用右美托咪定静脉泵入维持术中麻醉深度，P组使用丙泊酚静脉泵注。术后使用ICU专用谵妄评估表（CAM—ICU）评估是否发生谵妄。比较两组患者术后谵妄发生情况。结果 共有369例患者完成本次研究。62例在术后3d内发生了谵妄，谵妄发生率为11．3％，其中D组4．1％，P组16．7％（P=0．005）。D组患者术中芬太尼用量明显少于P组患者[（227．8±48．6）μg比（289．1±71．0）μg，P〈0．01）]。D组术后静息数字分级评分（NRS）低于P组[NRS：（4．0±1．2）分比（4．3±1．2）分，P〈0．05；平均NRS评分：（2．0±0．8）分比（1．8±0．8）分，P〈0．05]。D组患者术后杜冷丁使用比率明显低于P组[10．8％（20／186）比20．8％（38／183），P=0．0051。结论 与丙泊酚维持麻醉比较，术中使用右美托咪定可降低老年单侧膝关节置换术后谵妄的发生率。

Objective To investigate the effect of intraoperatively continuous infusion of Dexmedetomidine on postoperative delirium in the elderly patients undergoing selective unilateral knee replacement surgery in comparison with Propofol. Methods This was a prospective, randomized and controlled study. Elderly patients who were undergoing a selective unilateral knee replacement surgery from November 2012 to February 2014 in Beijing Jishuitan Hospital were enrolled. All patients were underwent nerve stimulator guided femoral nerve block, 0.4% ropivacaine 25 mL was gived, then the continuous femoral nerve catheter （CFNB） was inserted for postoperative analgesia. Combinded inhaled and intravenous general anesthesia was used intraoperatively. Patients were randomly assigned to receive either Dexmedetomidine （D） or Propofol （P） group intravenously by continuous infusion. Postoperative delirium was diagnosed after surgery using the confusion assessment method for the intensive care unit （CAM-ICU）, and the incidence of postoperative delirium was compared. Results A total of 369 cases of patients completed the study, and 62 cases experiencee postoperative delirium in the first 3 postoperative days, the whole incidence of delirium was 11.3%, which was 4.1% in group D, while 16.7% in group P （P=0.005）. The intraoperative fentanil consumption in group D was significantly lower than in group P [（227.8±48.6） μg vs （289.1±71.0）μg, P 〈 0.01]. The rest NRS scores in group D were lower than in group P [NRSmax （4.0±1.2） point vs （4.3±1.2） point, P 〈 0.05; NRSmean： （2.0±0.8） point vs （1.8±0.8） point, P 〈 0.05]. The ratio of postoperative dolantin consumption in group D was significantly lower than in group P [10.8% （20/186） vs 20.8% （38/ 183）, P=0.005]. Conclusion The use of Dexmedetomidine intraoperatively can reduce the incidence of postoperative delirium in elderly patients undergoing unilateral knee replacement surgery in comparison with Propofol.